Friday, October 2, 2015


      I had written in the past about the Emperor's new clothes. This term has been used in medicine for number of diseases, but it was used for pulmonary embolism many years ago . It was so true in past as we did not suspect in the diagnosis in past and so when it presented with some unusual symptoms, we missed it . But exactly opposite thing has happened.For last few years we do CT scan to diagnose pulmonary embolism . Now a days almost anybody and everybody who comes to hospital ER gets a CT scan with minimal or no symptoms suggestive of clots in the lungs. So we tend to diagnose more. The number of CT scans done has gone up by 1000%, again 1000%, not 100%. So it is unusual to miss the diagnosis of pulmonary embolism. But sometimes when we come across certain things quite often , we tend to not pay attention to them. This brings me to some stories that I am going to tell today.
      I saw this new patient who was 57 years of age I saw her in office as a new patient .She was a nonsmoker who had a diagnosis of asthma in the past and was given the inhaler She was using and was OK for a while . But then started having more shortness of the breath . So she saw her PCP and he promptly referred her to cardiologist. The cardiologist did number of tests . He did cardiogram and then the echocardiogram and then did the stress test. She also had holter monitor , which is continuous recording of the cardiogram . All the work up was negative and she was told that heart was OK and healthy. So she went back to PCP and so now she came to me . She was short of breath and also had passed out about 3 times in last 2 -3 months. 3 days before she saw me she was taking out her dog and passed out  and found herself on the side walk . She looked OK but when I checked her oxygen saturation it was 91%. Her lungs were clear and she had no wheezing . I got hold of her cardiac test and they were OK . I made her walk for 50 feet and her oxygen saturation dropped to 85%(normal is greater than 95%)and she was quite short of breath.I knew what the problem was . SHE WAS THROWING CLOTS . I decided to admit her and ordered the CT scan and it did show the clot. She had plenty of them  I had started her on blood thinner even before doing the CT scan . I did call the cardiologist . He decided to do a new procedure in which a catheter is inserted in the artery going to lung and then a clot buster is slowly dripped in . This dissolves the clot more quickly .She did very well .
     So the shortness of breath , passing out and the drop in oxygen with lungs sounding clear were all the clues to the diagnosis. But it took much longer to get to it !   

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