After significant physical exertion a 66-year-old man with deep vein thrombosis of the extremities developed shortness of breath, intense pain in the chest on the left, marked palpitations. The patient's condition is grave, his face is cyanotic, the cervical veins are swollen, BP is 60/40 mm Hg. What investigation method would be the most advisable in this case?

Answer options

1. Echocardiography
2. Fiber-optic bronchoscopy
3. Chest X-ray
4. Selective angiopneumography
5. Magnetic resonance imaging of the chest

Explanation

The most common presentation of a DVT is pain and swelling, especially in the calf, usually in one leg. Pulmonary embolism (according to the clinical signs and anamnesis – patient with deep vein thrombosis of the extremities developed shortness of breath, intense pain in the chest on the left, marked palpitations. The patient’s condition is grave, his face is cyanotic, the cervical veins are swollen, BP is 60/40 mm Hg). The diagnosis of DVT and pulmonary embolus should be established by special investigations as the symptoms and signs are non-specific and may be absent. In addition, treatment with anticoagulation is not without risk and the diagnosis must be made with reasonable certainty. Venous duplex ultrasound is commonly performed to look for evidence of thrombosis throughout the deep or superficial venous system. Pulmonary embolus is diagnosed definitively by computed tomography (CT) pulmonary angiogram, which will demonstrate the presence of filling defects in the pulmonary arteries. Pulmonary angiography is rarely required unless thrombolysis is being considered. Bailey & Love’s short practice of surgery. – 27th edition. – P. 986.