2005 Volume 16 Issue 4 Pages 275-281
A 71-year-old obese female took a long-distance bus trip for 16 hours. One week later she returned home by bus following the same route. After getting off the bus she began to feel discomfort in her left leg and suddenly developed shortness of breath after walking for about 100 meters. Nine days later she lost consciousness for a few seconds while walking to the rest room. Ten days later she lost consciousness again while changing her clothes. She was brought to our hospital in an ambulance. Acute pulmonary thromboembolism was provisionally diagnosed on the basis of her history, physical examination, laboratory data, and results of electrocardiography and echocardiography. An emergency pulmonary angiogram was performed, which revealed large thrombi in both the right and left pulmonary arteries. The pulmonary artery pressure was 73/31 (45) mmHg. Therefore, a temporary inferior vena cava (IVC) filter was placed below the renal veins. After she was admitted to coronary care unit, she was administered anticoagulation and thrombolytic therapies, which improved her condition. Magnetic resonance venography of both her lower legs revealed no deep vein thrombosis. The findings of all her blood tests were normal including coagulation ability. Chest computed tomography that was performed on the eighth day of admission revealed only small thrombi in the peripheral pulmonary arteries. The temporary IVC filter was extracted on the ninth day of hospitalization. She was discharged on the 12th day of hospitalization. Although she had shortness of breath immediately after the long-distance bus trip, diagnosis was not made until 10 days later when she lost consciousness. We have to consider the possibility of traveler’s thrombosis when patients develop symptoms such as shortness of breath after taking a long-distance
trip.
