A 55-year-old Caucasian man with no history of disease is admitted to Emergency Department after sudden onset of shortness of breath. He complains sharp chest pain that worsen while coughing.
The patient is a truck driver and he has been driving 18 hours a day without rest periods for a month. On admission, physical examination reveals a diaphoretic and dyspneic patient without focal neurologic findings. His heart rate is 128 beats/minute, his blood pressure is 126/72 mmHg without orthostatic changes, and his respiratory rate is 34 breaths/minute. Oxygen saturation is 90%, and arterial blood gas analysis in room air reveals hypoxemia (PO2 = 58 mmHg) with an elevated alveolo-arterial oxygen gradient (A-a O2 gradient). Examination of his head and neck is normal. The results of chest wall examination reveal reduced breath sounds bilaterally at the lung bases. The findings of heart and abdominal examinations are unremarkable, but on examination of his legs, deep venous thrombosis (DVT) signs are noted in his left leg with positive Homans’ sign.
Serum electrolytes, glucose, blood urea and creatinine, and complete blood counts are normal. Results of a computed tomographic scan of his head are negative for bleeding, aneurysm or an embolic event. Chest X-ray is clear. An electrocardiogram shows a regular rhythm consistent with sinus tachycardia. A ventilation-perfusion (V/Q) scan demonstrated an unmatched segmental perfusion defect. A Doppler scan of the legs revealed an acute DVT in the patient’s left popliteal vein.
What is the most probable diagnosis?
What are the warning signs of DVT?
What are the pathological consequences of this disease if left untreated?
What is your differential diagnosis? (list all the possible etiologies)
What are the various diagnostic tests for this disease?
What is the drug treatment of this patient?
How this condition can be prevented?
