Pulmonary Embolism

[MrTiTo1001]

QUESTION: According to research studies, what is my prognosis - of particular interest to me is knowing what is the likelihood of PE recurring?

BIO:

AGE: 40
SEX: MALE

PAST DIAGNOSIS: Erythema Multiforme, Recurrennt HSV, HTN, Allergic Rhinitis, Migraine, Benign Systolic Heart Murmur, Depression.

PAST SURGERY: NONE
FAMILY Hx: Hyperlipidemia, HTN, Cardiovascular Dsease, Prostate cancer.

MEDS: Plendil, Effexor, Acyclovir, Prednisone, Atarax, Warfarin, Flonase, Triamcinolone Cream, Imitrex.

BACKGROUND:

Thanks for your time. I recently collapsed, spending 1 week in hospital (telemetry and Med-Surg).

I was diagnosed with : Bi-lat P. E. in segmental pulmonary artery branches to the lower lobes, and in the right main pulmonary artery, including the bifurcation and extending into the bifurcation of the right main pulmonary artery. Wedge shaped area in the posterior aspect of the right middle lobe is indicative of infarct. Right Pleural effusion and bibasilar areas of consolidation may also represent infarct.

Also, doppler studies of legs showed: persistent occlusive DVT of left popliteal vein.

I'm now home and currently managed on Warfarin, analgesia and anti-embolus stockings.

I have no previous history of DVT or PE - MD's are baffled to the cause (still pending some lab results, but as of yet, all bloodwork is relatively normal).

Hope you can help - look forward to your response.

Tim

[Dallygirl]

Diagnosing the cause of DVTs & pulmonary emboli w/out any of the "risk factors" (such as abdominal/thoracic surgery, trauma to the site or extended periods of inactivity) can be frustrating.  A family member recently had multiple PEs caused by recurrent DVTs, despite anticoagulation therapy (both Heparin as an inpatient, Coumadin & Lovenox as an outpatient).  

Turns out the coagulation problems (causing the blood clots in her legs & lungs) were due to pancreatic cancer.  In other words, the malignant tumors were causing a clotting disorder in her blood.

While it is scary to entertain the idea of it, please consider tumor/s as a possible cause for ideopathic blood clots.

Best wishes for good health, Dallygirl

[National Jewish]

From your description, you have experienced fairly extensive, severe embolization.  You will have to work closely with your doctors to establish which of the above causes is most likely, in your case.

While leg veins are the most common site of thrombi that then embolize to the lung, such thrombi can also develop in the veins of the upper extremities, the large veins within the chest, from within the heart and even from the pelvic veins.  It is crucial that your evaluation be comprehensive and that the team of physicians conducting the evaluation include a coagulation specialist.  

The first order of business should include very careful monitoring of your anticoagulation therapy so that, whatever the cause, further clotting and embolizaiton be prevented, as that cause is sought.  The evaluation should be conducted with a sense of urgency.  

You note that your doctors 'are baffled'.  If this is truly the case, you should request of them that they seek consultation, for you, with the closest national experts in the diagnosis and care of thromboembolism.