OpenHealth Q&A

Seeking Insights on Unexplained Pulmonary Embolism

I am a 32-year-old male, standing at 5'9" and weighing 220 lbs. My primary health concern revolves around experiencing pulmonary embolisms. I do not smoke, consume alcohol, or use illicit drugs. I underwent surgery for kidney stones in November 2024, during which a stent was placed and later self-removed. My current medications include 200mg of Sertraline, 15mg of Adderall XR, and Propranolol, which was prescribed after my pulmonary embolism diagnosis, as well as Eliquis. Occasionally, I take Trazodone at 50mg to assist with sleep. Although I previously had a testosterone gel that I didn’t consistently use, my doctor believes it’s unrelated to my current condition. My primary care physician has indicated that I do not require further follow-up appointments, yet I am eager to understand the reasons behind the occurrence of these embolisms. In January, I visited the emergency room due to severe food poisoning—a situation I typically avoid. After being in distress and dry heaving for several hours, I went to the hospital just across the street. I received morphine and other medications to combat the food poisoning, followed by a CT scan of my abdomen. The images revealed two pulmonary embolisms. A detailed account of all test results can be found at the end of this post. While admitted to the emergency department, I was given a heparin drip for the duration of my stay and monitored for one night. A potentially relevant detail is that a few weeks before my emergency visit, I experienced significant pain in my lower back—not muscular pain, but rather a discomfort near my ribs close to the spine, which I suspect relates to the location of the embolisms. Although I was able to breathe normally, the pain hindered my ability to take deep breaths. This discomfort emerged without warning while I was shopping in Target and severely affected my ability to sleep. I believe this might have been the precursor to the pulmonary embolisms, as I did not experience any leg pain or other symptoms; the back pain was isolated and alleviated within a day. As for my oxygen levels, they ranged between 94% and 97%. My heart rate fluctuated between 70 and 110 beats per minute, lacking consistency. **CT Scan Findings**: 1. **Scan 1**: - **Technique**: Contrast via intravenous method only, with limited evaluation of the bowel due to no oral contrast. - **Results**: A filling defect was observed in the right lower lobe branch of the pulmonary arteries, indicative of a pulmonary embolus. No abnormalities were noted in the lungs, liver, spleen, pancreas, adrenals, or kidneys. Other abdominal structures also appeared normal except for an under-evaluated bladder. The report highlighted a critical finding of a right lower lobe pulmonary embolus. 2. **Scan 2**: - **History**: Confirmed presence of pulmonary embolism on previous CT scan. - **Technique**: Thin section non-contrast images followed by contrast images for optimal assessment of thoracic vasculature. - **Findings**: Bilateral lower lobe segmental and subsegmental pulmonary emboli were identified with mild clot burden. There were no signs of right heart strain, and the lungs appeared clear with no effusions or infarcts. **EKG Results**: - Ventricular Rate: 99 BPM - Interpretation indicated normal sinus rhythm without significant ST elevation. **Lower Extremity Ultrasound**: - Conducted to evaluate for DVT due to swollen extremities. The examination showed no signs of deep venous thrombosis or superficial thrombophlebitis; all major veins examined were compressible with normal flow. **Echocardiogram Findings**: - It indicated normal left ventricular function and mild dilation in both the left and right atrium. Minor regurgitation was observed in the mitral and tricuspid valves, but no significant issues were reported. Overall, the echocardiogram provided reassurance regarding heart function, but I am considering whether consulting additional specialists is prudent or if my situation warrants further investigation. I would appreciate any thoughts or recommendations on how best to proceed with my healthcare.

Answers (1)

3/18/2025, 3:50:54 AM

OpenHealth AI

It sounds like you have quite a complex medical history and understandably want to find clarity regarding your experience with pulmonary embolisms (PE). Here’s a structured overview of your situation and some actionable steps going forward.

Main Points

1. You have experienced pulmonary embolisms that may be linked to a variety of factors.
2. Pain prior to your diagnosis might indicate an underlying issue, but no clear source of the embolisms has been identified yet.
3. Further evaluation and lifestyle considerations may be beneficial.

Explanation

Pulmonary embolisms arise when a blood clot travels to the lungs, blocking blood flow. Factors contributing to the development of PE can include:

• Prolonged immobility (such as long flights or bed rest)
• Surgery (which you've had)
• Certain medications (some may contribute to clotting risk)
• Underlying health conditions

Your history of significant back pain might suggest an earlier issue, but it’s less common for back pain to be directly related to the development of pulmonary embolisms unless associated with other risk factors. Your normal echocardiogram and negative DVT ultrasound are reassuring but don't eliminate the need to look deeper into potential causes.

Next Steps

1. Monitor Your Symptoms:

   • Keep track of any new or recurring symptoms like chest pain, shortness of breath, or unusual leg pain and communicate these to your healthcare provider.

2. Follow-Up with a Hematologist:

   • Given the unexplained nature of your PE, it might be valuable to consult a hematologist (blood specialist) to rule out any clotting disorders. Conditions that increase clotting tendency may not always surface in standard tests.

3. Discuss Lifestyle Modifications:

   • Aim to maintain healthy body weight through balanced nutrition and regular physical activity, as obesity can increase the risk of embolisms.
   • Stay active to promote circulation, especially if your lifestyle includes periods of inactivity.

4. Medication Review:

   • Continue following your current medication regime, but discuss with your doctor whether adjustments or monitoring are needed, as some medications can influence bleeding risk or clotting.

5. Consider a Sleep Assessment:

   • If sleep issues persist, don't hesitate to look into a sleep assessment, especially since Trazodone is used occasionally.

6. Stay Informed:

   • Document all your symptoms and concerns and bring this information to any follow-up consults. Keeping a journal can empower your discussions with healthcare providers.

Conclusion

Addressing your pulmonary embolism may require a nuanced approach beyond immediate medical treatment, exploring lifestyle factors, and possibly genetic predispositions. You're proactive in seeking knowledge, which is vital for managing your health moving forward. Don’t hesitate to express your concerns during appointments, as being informed helps tailor your healthcare journey more effectively.