Avatar universal

Bilateral PEs and costochondritis

I am a 40 year fit and active woman who has a fairly hectic working life that involves quite a bit of overseas travel. In good health and not taking OCP and do not smoke. At the end of January 2008 I was on a short flight (less than 2hours) and the next day I was extremely short of breath and had chest pain. I was admitted to hospital and was diagnosed as having bilateral popliteal DVTs and bilateral pulmonary emboli.

The CT scan report said: In the right lung large embolus in the right pulmonary artery and this extends into the lobe of branches of both the uppwe and lower lobe pulmonary artery. On the left large embolism in branch of pulmonary artery to the left lower lobe and a smaller embolus in the branch to the left upper lobe. The echo of my heart showed that my right heart was midly dilated, a mild TR and PA systolic pressure of 35mmHg. The ECG showed poor R wave progression and anterolateral T wave inversion. Interestingly my D-dimer test that was done on admission came back negative.

I am now on a therapeutic INR of 3.0-3.5 and taking 7mg daily warfarin. My exercise tolerance has increased and I am now able to walk about 500m without becoming too short of breath. Over the last couple of weeks I have had quite a lot of chest pain and discomfort and that was diagnosed as costochondritis. The last couple of days the chest pain has increased and I am having to take painkillers on a more frequent basis, especially to sleep. I am feeling pretty low and have been extremely tired since I have come out of hospital.

I have two main areas that I'd be grateful for some input on:

1. How severe were the PEs that I had? Are these relatively small clots or are they fairly substantial and what implications does this have for my recovery?

2. What is this costochondritis that the doctor says I now have and how is it related to my PEs? I'm worried that this pain may be from my heart or may be due to more clots going into the lungs.

Many thanks for all your help.
3 Responses
242588 tn?1224271700
First, as described, these are fairly substantial clots on the basis of size, extension, and acute pulmonary hypertension with dilatation of the right heart.  They are substantial, but not severe as would be the case with vascular collapse and/or respiratory failure.  The size and extent of the emboli are such that complete lysis or resolution of the clot might be delayed or not occur, with resultant residual organized clot and increased resistance to flow in the pulmonary circulation.  If a large enough residual, it could lead to chronic pulmonary hypertension, with chronic right heart strain and/or in some instances, shunting of blood (at the atrial level) from the right heart to the left heart through a patent foramen ovale.  For all of the preceding reasons, and especially with the recent onset of chest pain, you should have a cardio-pulmonary reevaluation at this time, with a CT scan and an ECHO to assess pulmonary hypertension.  It is possible that you coincidentally do have costochondritis.  On the other hand, pulmonary hypertension can cause chest pain and right heart failure.  If dilatation is more than mild it might compromise coronary artery circulation.  In essence, you and your doctors will want to be sure that the pain truly is of musculoskeletal origin and not a reflection of compromised cardio-pulmonary function.

Your tiredness may just be a residual of your having experienced a powerful shock to your body and your sense of bodily integrity.  Or, it could be a reflection of low cardiac output.

In essence, your second expression of concern is valid and should be taken seriously; at least seriously enough for your doctors to entertain the possibility that your chest pain may not be costochondritis.  If they choose not to, you should request a second opinion.
Avatar universal
Hi. Did I not provide the right information? I just wonder as I haven't had any replies and I tried to give sufficient information. Perhaps you could let me know.
Avatar universal
Thanks so much for your informative reply. I will discuss your points with my doctor. Great service and very much appreciated. Thanks again.

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