Thrombocytopenia as First Manifestation of Acute Massive Pulmonary Embolism

Massive acute pulmonary embolism (PE) is a life-threatening medical condition. Occasionally, patients experiencing a massive PE may develop concurrent thrombocytopenia. A 64-year-old female was admitted for left femur osteomyelitis with a sub-periosteal abscess that was causing pain and immobility. There were no indications suggesting underlying thrombophilia or malignancy. On day 5 of admission, the patient developed acute onset respiratory distress, necessitating intubation and vasopressor support. A computed tomography pulmonary angiogram revealed a massive PE involving the left main trunk and left ascending pulmonary artery. The patient had experienced an unexplained worsening thrombocytopenia that despite without heparin use previously. There was clear indication for thrombolysis, but the treatment was contraindicated. After a multidisciplinary meeting it was decided to optimize platelet counts prior to the performance of a surgical embolectomy, however the patient succumbed 2 days later. The unexplained thrombocytopenia could be the only clue for massive PE. Clinicians should remain vigilant to ensure early diagnosis and improved outcomes.

Akut Masif Pulmoner Embolinin Ýlk Belirtisi Olarak Trombositopeni

Masif pulmoner emboli (PE) hayatý tehdit eden medikal bir durumdur. Bazen, masif PE geçiren hastalarda, eþlik eden bir trombositopeni görülebilir. Sol femurda aðrý ve hareket kýsýtlýðýna neden olan subperiostal apseli osteomiyeliti bulunan 64 yaþýndaki kadýn hasta yatýrýldý. Altta yatan trombofili veya maligniteyi düþündüren bir bulgusu yoktu. Yatýþýn beþinci gününde, vasopresör desteði ve entübasyon gerektiren akut bir solunum sýkýntýsý ortaya çýktý. Pulmoner tomografik angiografide, sol inen pulmoner arter ve sol ana pulmoner arterde masif bir pulmoner emboli görüldü. Öncesinde heparin kullanmamasýna raðmen açýklanamayan trombositopeni geliþti. Trombolitik tedavi ihtiyacý olmasýna raðmen, bu tedavi kontrendike idi. Multidisipliner bir toplantýda cerrahi embolektomi öncesi trombosit sayýsýný düzeltme kararý alýndý. Ancak hasta iki gün içinde kaybedildi. Açýklanamayan bir trombositopeni masif PE için tek ipucu olabilir. Klinisyenlerin, erken taný ve daha iyi sonuçlar elde etmeleri için dikkatli olmalarý gerekir.