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The working diagnosis was Massive PE, with concerns for AAA vs AD given the acute onset of symptoms, severity of illness, and vague epigastric abdominal pain (non-lateralizing pleuritic pain). TPA was considered from the begining, but with an equivocal Echo, and good response to IVF, it was felt that the patient was much more stable, and we could wait for more appropriate testing. A CT Chest/Abdo/Pelvis Non-contrast was obtained, showing no AAA, no retroperitoneal bleed, and a narrow mediastinum (although can't really comment on presence or absence of AD). There was also a moderate hiatal hernia and hilar lymph nodes which were visualized on the CT which were felt to be responsible for the "effusion" and "moderately widened mediastinum" seen on the previous portable CXR.
Repeat vitals on return from CT were 105/75, 105, 20, 98% 6L NC. The patient was started on a heparin gtt, received his 2 units pRBCs, and admitted to the MICU for suspected massive PE. He remained stable.
The following day, the patient received an IVC filter courtesy of IR. He went for V/Q scan 2 days later which was read as high-probability.
Repeat vitals on return from CT were 105/75, 105, 20, 98% 6L NC. The patient was started on a heparin gtt, received his 2 units pRBCs, and admitted to the MICU for suspected massive PE. He remained stable.
The following day, the patient received an IVC filter courtesy of IR. He went for V/Q scan 2 days later which was read as high-probability.
