Pulmonary Thromboembolism in a Patient Suspected for Myocarditis - Case Report

Abstract

BACKGROUND: The following case presentation highlights the diagnostic and therapeutic approach to a patient with a rare disease. CASE PRESENTATION: A 47-year-old man was hospitalized with chest pain, shortness of breath, and fatigue. Initial blood test analysis revealed elevated CRP, leukocytosis, and elevated cTn-I. Due to suspected myocarditis, cardiac magnetic resonance (CMR) imaging was performed. CMR ruled out myocarditis. In addition, there were no signs of edema or late gadolinium enhancement (LGE). However, there was evidence of enlarged right ventricular heart chambers. Cine short-axis images and LGE sequences revealed masses in the pulmonary artery, highly suspicious of thrombi.  D-dimer was analyzed, showing very high values, and additionally, CTPA confirmed the diagnosis of pulmonary embolism (PE). Venous Doppler ultrasonography demonstrated DVT in the right popliteal vein. Anticoagulation with LMWH was initiated, after which a drug from the NOAC class - Rivaroxaban was given according to a PE protocol. The patient was discharged from the hospital in a hemodynamically stable condition with a recommendation to adhere to the therapy and conduct control after 1 and 3 months of hospitalization. CONCLUSION: Thanks to multimodality imaging, we find it easier to get the specific cause of the problem, by establishing it or by ruling it out. However, the most important thing is to have a high clinical suspicion and common sense for faster diagnosis, treatment, and early recovery of the patient.