A Curious Cause of Pulmonary Embolism

​BY BRUNA ALMEIDA, & AHMED RAZIUDDIN, MDA 30-year-old man presented to the ED with dyspnea and pleuritic chest pain radiating to his left shoulder that had started three days before. He was at a “sex party” four days earlier, and had used amphetamines and gamma-hydroxybutyric acid (GHB, also called Liquid G).The patient said deep breaths and movement worsened his pain. He also had exertional shortness of breath and occasional palpitations. He denied fever, cough, loss of consciousness, recent surgery, and prolonged immobilization. The patient had no personal or family history of DVT, PE, or cardiac conditions. He was a bodybuilder, and his last workout was five days earlier. Besides its use as “Liquid Ecstasy,” GHB is also used by bodybuilders. The patient was HIV-positive with an undetectable viral load.His temperature was 97.2°F, blood pressure was 144/88 mm Hg, pulse rate was 81 bpm, and respiratory rate was 22 bpm. Oxygen saturation was 94% on room air. His cardiac exam showed a regular rate and rhythm, normal S1 + S2, no S3/S4, and no reproducible pain on palpation. His lungs were clear to auscultation.His laboratory studies revealed a troponin I of 0.08 ng/ml, a D-dimer of 2920 ng/ml, and hepatitis A and hepatitis B nonreactive. Urine toxicology revealed that he was positive for amphetamines and opiates.A chest x-ray showed left lower lung opacity. A CT angiogram was performed, and bilateral segmental filling defects were present in the pulmonary arteries...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research