Pneumonia and concealed pulmonary embolism: A case report and literature review

Abstract

Pneumonia is one of the illnesses for which pulmonary embolism (PE) is most often mistaken because of the considerable overlap in their clinical picture. Moreover, pneumonia may occasionally mask PE, particularly in patients with predominant systemic symptoms such as fever, and with no evidence of deep vein thrombosis (DVT) or trauma. In this report, we presented a 35-year-old male patient with pneumonia and PE in whom pneumonia initially masked the diagnosis of PE. The patient presented with fever, productive cough associated with streaks of blood and pleuritic chest pain for 3 days duration, and was admitted as a case of lobar pneumonia based on his clinical presentation as well as on chest X-ray and non-enhanced computed tomography chest. He had an initial improvement in response to antibiotics; however, during his follow-up at the clinic, he appeared sick, complaining of right-sided persistent pleuritic chest pain and persistent cough, occasionally associated with streaks of blood and breathlessness on exertion. The patient was readmitted and PE was confirmed by computed tomography pulmonary angiography. Anticoagulation initiated with noticeable clinical improvement. This case highlights the importance of considering PE in patients with pneumonia when there was an initial therapeutic response followed by worsening of the condition during the treatment of pneumonia.

Keywords: computed tomography pulmonary angiography; pneumonia; pulmonary embolism; pulmonary infarction.