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.
