Dyspnea in adults in the context of syncope – a clinical case of pulmonary embolism

Abstract

Background. Dyspnea is a frequent symptom encountered in ED, often with various etiologies, ranging from minor conditions to acute life-threatening illnesses. When associated with syncopal episodes, it requires a rapid, efficient, and multidisciplinary approach to prevent severe decompensation and fatal complications. Objective(s). To present a complex clinical case of pulmonary embolism manifesting through syncope and dyspnea, highlighting the importance of integrative evaluation and early diagnosis in respiratory emergencies. Materials and methods. A 73-year-old female patient was brought by the emergency medical team to the Emergency Department (ED) of in by the EMS team with a presumptive diagnosis of “syncope of unknown etiology.” Continuous monitoring was initiated, followed by advanced imaging investigations, including non-contrast chest CT and pulmonary CT angiography. Results. At the time of admission, the patient reported dyspnea and low oxygen saturation (SpO₂). Pulmonary CT angiography revealed thrombotic masses at the bifurcation of the main pulmonary artery, with bilateral extension into the lobar and segmental branches of the pulmonary arteries, some with an occlusive appearance. A diagnosis of massive pulmonary embolism was rapidly established, and emergency-specific treatment was promptly initiated. Conclusion(s). Sudden-onset dyspnea associated with syncope may indicate a serious cardiovascular condition such as pulmonary embolism. The presented case emphasizes the importance of rapid, multidisciplinary, and imaging-oriented evaluation in the red zone of the ED which is essential for the patient’s prognosis.