This case is a 28 year old male who was involved in a motor vehicle accident and suffered a C6 vertebral fracture and paraplegia. His admission chest x-ray was unremarkable except for the presence of a tracheostomy tube. He did well until 2 weeks after the trauma when he complained of acute respiratory distress without cough, chest pain or hemoptysis. The chest x-ray now shows a left sided effusion and bilateral lower lobe densities that silhouette the diaphragms. These findings were not present on the prior exam.
Portable perfusion shows reduction in perfusion in the right upper lobe.
The angiogram demonstrated a thrombus in the anterior segment of the right upper lobe. This is the case of a 28 year old male paraplegic who presents with acute dyspnea and respiratory alkalosis. Dyspnea is a common but not ubiquitous symptom. This symptom is often associated with evidence of hyperventilation as in this case respiratory alkalosis. Most patients with pulmonary embolus have a predisposition to deep venous thrombosis.