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Journal of Case Reports
An Atypical Presentation of Massive Pulmonary Embolism
Tavishala Amarasimha Reddy, Wasil Rasool Sheikh, Meghna Haldar, Ankur Verma, Sanjay Jaiswal 
Department of Emergency Medicine, Max Super Speciality Hospital, I.P.Extension, New Delhi, India.
Corresponding Author:
Dr. Tavishala Amarasimha Reddy 
Email: amarasimhareddy@gmail.com 
Received: 19-NOV-2017 Accepted: 27-FEB-2018 Published Online: 15-MAR-2018
DOI: http://dx.doi.org/10.17659/01.2018.0019
Background: Pulmonary embolism (PE) is an obstructive disease of the pulmonary arterial system caused by the embolization of thrombus originating from the deep veins of the lower extremities. Almost 25% patients of PE present with sudden cardiac death and not all patients may have classical symptoms. Hyper-coagulable states have been reported to cause cerebrovascular and myocardial thrombosis but rarely PE. Case Report: We present a case of a 27 year old male who presented to the Emergency Department with complaints of low backache and giddiness. Patient was found to be tachycardic, tachypneic and in shock. Patient had a low probability of PE with a Well’s score of 1.5 but was diagnosed as having massive bilateral acute pulmonary embolism with deep vein thrombosis secondary to protein C deficiency. Conclusions: It is imperative for emergency physicians to have a high index of suspicion in young patients presenting with atypical symptoms and low clinical probability for PE in order to thrombolyse the patient on time. 
Keywords : Adult, Pulmonary Embolism, Protein C Deficiency, Pulmonary Artery, Venous Thrombosis.
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