The Diagnostic Dilemma between Pulmonary Embolism with Positive Chest Imaging and Pneumonia: A Case Report and Literature Review - Abstract
Background: Although the last decades have witnessed more pulmonary embolism (PE) in China, PE in young adults is rare. Here we reported a young man of saddle PE with several lung infiltrations in imaging which was misdiagnosed as pneumonia for three times.
Case review: A 25-year-old man, presenting no obvious risk factors for PE, was finally diagnosed as saddle PE. However, during the whole process of diagnosis and treatment, the patient was misdiagnosed as pneumonia three times. He presented with left chest pain with difficulty breathing, mild cough, and sputum. Considering the imaging, and clinical manifestations, the patient was diagnosed as pneumonia. He suffered from sudden right chest pain, dyspnea, and tachycardia later. The D-dimer increased significantly, accompanied by mild hypoxemia and hyperventilation. CT
pulmonary angiography (CTPA) revealed a saddle PE (medium risk).
Conclusions: The clinical features of pneumonia and PE differ. PE has a more sudden onset, and the dyspnea is more prominent than cough and sputum. PE usually has a dyspnea unmatching with the changes in imaging, and has no response to antibiotics. Pneumonia has a progressive onset, with more prominent cough, sputum, and fever. The dyspnea of pneumonia basically matches with the pulmonary infiltrates in imaging. Pneumonia is sensitive to antibiotics. Therefore, attention should be paid to young PE patients without obvious incentives. The differentiation between pneumonia
and PE should be carefully conducted, and the diagnostic procedure of PE should be
correctly applied, in order to timely diagnose and treat this type of disease.