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Case Reports
. 2025 Jan 27;17(1):e78107.
doi: 10.7759/cureus.78107. eCollection 2025 Jan.

Massive Bilateral Pulmonary Embolism in a Healthy 37-Year-Old Male: A Case of Atypical Presentation

Salah A Mustafa  1 , Ehab M Abbas  2 , Essa A Alkhalifa  3 , Ali S Buallay  2
Affiliations
Case Reports

Massive Bilateral Pulmonary Embolism in a Healthy 37-Year-Old Male: A Case of Atypical Presentation

Salah A Mustafa et al. Cureus. .

Abstract

Pulmonary embolism (PE) is a potentially fatal condition caused by the obstruction of pulmonary arteries by a blood clot, commonly originating from deep vein thrombosis (DVT). Although traditional risk factors include recent surgery, immobility, cancer, or thrombophilia, PE can also occur in patients without these predisposing factors, presenting significant diagnostic challenges. In this case report, we present a 37-year-old Pakistani male with no significant medical history who suffered a massive PE. The patient experienced an initial collapse at home and a second collapse en route to the hospital, necessitating cardiopulmonary resuscitation (CPR). Despite the absence of conventional risk factors, emergent diagnosis and prompt treatment, including thrombolysis and anticoagulation, led to a positive outcome. This case underscores the importance of maintaining a high index of suspicion for PE, even in atypical presentations. It emphasizes the need for clinicians to include PE in the differential diagnosis for sudden collapse, ensuring timely intervention and improved survival rates.

Keywords: atypical presentation; differential diagnosis; early diagnosis; hemodynamic instability; massive pulmonary embolism; pulmonary embolism; risk factors.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. RMS-MH (Royal Medical Services - Military Hospital) issued approval 2024-888. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Initial ECG on arrival to the hospital
Figure 2
Figure 2. The CT pulmonary angiogram demonstrates a filling defect within the right and left pulmonary arteries, consistent with a massive bilateral pulmonary embolism
The thrombus is visible as an area of low attenuation in the main pulmonary arteries, showing obstruction of blood flow.
Figure 3
Figure 3. The CT pulmonary angiogram demonstrates filling defects within the right and left pulmonary arteries, extending into their branches and consistent with bilateral pulmonary emboli
Figure 4
Figure 4. The CT pulmonary angiogram shows prominent filling defects in both the right and left pulmonary arteries, confirming the presence of bilateral pulmonary emboli
The thrombi are within the central pulmonary arteries and extend into their proximal branches.
See this image and copyright information in PMC

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