Akut Dispne ile Başvuran Hastada Eşzamanlı Yaşamı Tehdit Eden Torasik Patolojiler: Tanısal Zorluk Yaratan Nadir Bir Olgu
Özet
Akut pulmoner emboli (PE) acil serviste sık görülen, yaşamı tehdit edebilen ve tanı için yüksek klinik şüphe gerektiren bir tablodur. Pnömotoraks, plevral efüzyon ve pnömoni gibi eşlik eden torasik patolojiler klinik görünümü maskeleyerek tanıyı geciktirebilir. Malign plevral mezotelyoma öyküsü olan 78 yaşındaki erkek hasta akut dispne ile başvurdu ve masif sağ pnömotoraks ve plevral efüzyon, bilateral derin ven trombozu ve pulmoner trunkustan her iki ana pulmoner artere uzanan geniş PE ile pnömoni ya da pulmoner infarkt düşündüren infiltratlar saptandı.Tüp torakostomi ve yeterli sıvı resüsitasyonuna rağmen gelişen persistan hipotansiyon nedeniyle hasta hemodinamik instabil kabul edilerek multidisipliner kararla sistemik tromboliz uygulandı; ancak klinik kötüleşme sürdü ve hasta 11. günde exitus kabul edildi. Bu olgu, akut dispnede eşlik eden patolojilerin birbirini maskeleyebileceğini, ilk tanıya aşırı odaklanmadan geniş ayırıcı tanıyı sürdürmenin ve eşzamanlı ölümcül durumları erken yönetmenin kritik olduğunu vurgular.
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