BMJ Case Reports 2013; doi:10.1136/bcr-2012-008197
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Massive pulmonary embolism and thrombophilia

  1. Asad Ali
  1. University Hospital Coventry and Warwickshire, Coventry, UK
  1. Correspondence to Dr. Iman Qureshi, Iman23{at}


A 32-year-old man presented overnight to the accident and emergency unit with mild breathlessness on exertion. He was found to be hypoxic on room air and his chest x-ray revealed areas of patchy lung consolidation. He was given intravenous antibiotics for presumed community-acquired pneumonia. Unfortunately his condition deteriorated and he remained significantly hypoxic despite high-flow oxygen with ECG evidence of right heart strain. Further questioning revealed a history of protein S deficiency and a strong family history of venous thromboembolic disease. An urgent CT pulmonary angiogram showed an evidence of massive pulmonary embolism and the patient was successfully thrombolysed.

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