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. 2020 Nov;4(4):551-554.
doi: 10.5811/cpcem.2020.7.47887.

Case Report: A Near Miss of Pulmonary Embolism in a Division 1 Collegiate Basketball Player

Nicholas M Chill  1 , Aaron J Monseau  1 , Brenden J Balcik  1 , Rosanna D Sikora  1 , Kathryn Oppenlander  1
Affiliations

Case Report: A Near Miss of Pulmonary Embolism in a Division 1 Collegiate Basketball Player

Nicholas M Chill et al. Clin Pract Cases Emerg Med. 2020 Nov.

Abstract

Introduction: The clinical presentation of pulmonary embolism (PE) is often associated with classic vital instability such as tachycardia, hypoxia, and tachypnea. This critical diagnosis is often less likely if a patient is negative by Pulmonary Embolism Rule-Out Criteria (PERC) standards with a low pre-test probability of disease. Caution must be used when evaluating elite athletes with the PERC rule due to low resting heart rate and certain risk factors, which are inherent to athletics.

Case report: We report the case of a 20-year-old male Division 1 collegiate athlete with pleuritic chest pain diagnosed with PE despite being PERC negative. His presenting heart rate (HR) of 79 beats per minute was correctly determined to be tachycardic relative to his resting HR of 47-60 beats per minute. Despite his PERC negative status, PE was found after an elevated D-dimer and subsequent computed tomography angiography.

Conclusion: Special consideration should be used when evaluating elite athletes for PE, as their resting physiology may differ from the general population. Additionally, certain risk factors for thromboembolic disease are inherent in competitive athletics and should be considered during an initial risk assessment. The presented patient was successfully treated with oral anticoagulation for three months and was able to return to play.

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Conflict of interest statement

Conflicts of Interest: By the CPC-EM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.

Figures

Image
Image
Computed tomographic angiography of the chest in coronal (left) and axial (right) views. Arrows point to pulmonary embolism involving the right posterior basal segmental pulmonary artery (left) and associated hemorrhage versus developing pulmonary infarct (right).
See this image and copyright information in PMC

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