Resolved question:
I actually have a two-part question. First, a little background history: My 20 year old daughter (who had been sick for 2 weeks with a virus) came to a follow up appointment complaining of chest pain with 8-9 out of a possible 10 pain level. She was given an x-ray and told to go home to wait for results. She asked "what about my pain - it's REALLY bad, I can't get comfortable in any position and I've never felt pain like this before). The doctor asks her if she has motrin and to take that. She tells him she has took 3 and it isn't even taking the edge off - he informed her to take another one and sent her on her way home.
A little later, someone calls her and tells her the x-ray indicates she has bronchitus and that there's nothing to be concerned about.
Less than 7 hours later, she was in the ER because the pain hadn't subsided - she was unable to sleep and the extra motrin had done NOTHING for the pain.
More tests were done and she was diagnosed with a Pulmonary Embolism with pulmonary Infarction.
Also, she listed Nuvaring as a medicine she was on which I feel, should have alerted the doctor she went to earlier (before the ER and admission to the hospital) to the possibility of PE. I am so grateful my daughter is still here with me and I realize it could be so much worse... but, I am REALLY angry that she was sent home like trash with such a serious condition, and that she was in so much pain for so many hours because he assured her there was nothing serious going on.
So, my first question is - should the doctor have tested further given the level of pain she complained of? I'm definitely not a doctor but I think a level of 8-9 out of 10 pain might hint there is more going on than "your chest is sore because you've been coughing for a couple of weeks."
My second question is, how long does it usually take from the time the blood clots go to the lungs until a pulmonary infarction develops? He assured us a "very, very tiny" piece of her lung died (which insulted me as it felt that he was seriously down-playing it's significance) - but are there long-term consequences of this and if so, what should I be worried about as a parent.
Submitted:
4 Days
Category:
Pulmonologist
Hello.
Thank you for your query at DoctorSpring.com.
I understand your concern and agitation as a mother. I am glad to know that your daughter is doing well now.
Pulmonary embolism is something rare and I would not consider it as the first diagnosis in a 20 year old female with her symptoms.
Of course, a history of hormone therapy will make it more likely. The prediction score changes with that history. However, it would still not be the first diagnosis on a list of differentials.
Pain is a subjective symptom and the pain scale is not a standard tool for coming to any diagnosis.
And I will not blame the doctor who did not want to expose a young female to unnecessary radiation in the first step of management.
As to the damage to the lung (pulmonary infarct) cannot be quantified now. However, it will be quite small as the lung has a dual blood supply. There is nothing much to worry about in the long term.
I assume you might have received adequate treatment and advice on prophylaxis.
I would like to repeat it and suggest prophylaxis againt thrombosis for a minimum of 3 months.
Also, a follow up Ventilation/Perfusion (V/Q) scan after 2 weeks needs to be done to precisely quantify the damage to the lung.
I hope this was helpful.
Please feel free to ask further questions or clarifications if needed.
Regards,
Dr. Jacob George P,
MD, IDCCM, FCCP.