Clinical Analysis Of Chronic Obstructive Pulmonary Disease Complicated With Acute Pulmonary Thromboembolism

Objective:By investigating the clinical manifestations, signs, auxiliary examinations, diagnosis and prognosis of chronic obstructive pulmonary disease (COPD) complicated with pulmonary thromboembolism (PTE), we can raise clinicians awareness on this diease.Methods:4 cases of COPD complicated with PTE admitted to Sir Run Run Shaw hospital from January 2009 to May 2010 were retrospectively reviewed. The clinical manifestations, lab tests, radiographic characteristics, diagnosis and prognosis of these cases were analyzed.Results:clinical manifestations:3 cases presented with progressive dyspnea,2 cases with syncope, only 1 case with progressive cough with purulent sputum. Physical examination:we can see 2 cases here whose heart rates were over 100/min and respiratory rates were from 25 to 30/min. Blood pressure of 1 case was lower than 90/60mmHg. Diffuse bilateral rales were heard in 3 cases and wheeze in 1 case. Jugular venous distension was observed in 1 patient. Only 1 patient presented with lower extremity edema, and the circumference of right crus was 1.4cm longer than the left one. Blood gas analysis:4 patients had hypoxemia, and their Pa (A-a) 02 were all over 20mmHg. D-dimer (D-Di) of 3 cases were from 1 to 5ug/ml, while one patient was over than 5ug/ml. Doppler ultrasound on lower extremity venous:2 cases were considered as thrombosis, 1case was suspect and the other one was normal. Echocardiography:3 patients with moderate pulmonary hypertension, as well as high in 1 case. CT pulmonary angiography (CTPA):filling defects in the pulmonary arteries above segmental artery could be seen in all of these cases. Treatment:1 patient died after 2 months' active treatment because of seriously infection. However, the other 3 cases were all relieved.Conclusions:Although there are the uncharacteristic symptoms and signs between COPD and PTE, sudden syncope can call our attention to PTE. The confirmation of diagnosis for PTE depends on CTPA, but the D-Di, Doppler ultrasound on lower extremity venous also can help us. Analysis of symptoms, signs and results of all of the auxiliary examinations can be very helpful for us to determine the diagnosis. Thus patients' prognosis could be improved by early detection and early treatment.