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ARS Home » Southeast Area » Little Rock, Arkansas » Arkansas Children's Nutrition Center » Microbiome and Metabolism Research » Research » Publications at this Location » Publication #427804
Research Project: Early Life Factors and Microbiota Impact on Healthy Development

Location: Microbiome and Metabolism Research

Title: Abnormal Exercise Gas Exchange Before Pulmonary Emboli Diagnosis

Author
item EDWARDS, TIMOTHY - Arkansas Children'S Nutrition Research Center (ACNC)
item BØRSHEIM, ELISABET - University Arkansas For Medical Sciences (UAMS)
item TOMLINSON, ANDREW - University Of Texas Southwestern Medical Center

Submitted to: Mayo Clinic Proceedings
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 11/7/2024
Publication Date: 11/13/2024
Citation: Edwards, T., Børsheim, E., Tomlinson, A. 2024. Abnormal Exercise Gas Exchange Before Pulmonary Emboli Diagnosis. Mayo Clinic Proceedings. 8(6):530-535. https://doi.org/10.1016/j.mayocpiqo.2024.10.001.
DOI: https://doi.org/10.1016/j.mayocpiqo.2024.10.001

Interpretive Summary: Pulmonary vascular diseases, like pulmonary embolism (PE), affect about 500,000-600,000 people each year in the U.S., leading to around 200,000-300,000 deaths annually. While PE is more common in older adults, it can also happen to young, healthy individuals, often making it harder to diagnose due to vague symptoms. Cardiopulmonary exercise testing (CPET) is a tool that helps doctors evaluate how well the heart and lungs respond to physical activity. In this case report, we detail a missed chance by an outside testing facility to make a diagnosis. Through our second opinion analysis, we highlight key signs of pulmonary vascular disease seen during CPET, and share information to support earlier detection.

Technical Abstract: A 20-year-old male underwent diagnostic testing due to unexplained shortness of breath and chest discomfort. He had no previous medical problems and was not taking any medications. Initial evaluations included cardiopulmonary exercise testing (CPET), which yielded results that were reported as normal. However, over the following 2 months, his symptoms worsened considerably, including dyspnea with climbing stairs and then hemoptysis. Seeking urgent medical care, he presented to the emergency department, where he underwent further testing and was admitted to the hospital. Computed tomography angiogram reported bilateral pulmonary emboli. His parents requested a second opinion regarding the analysis of the CPET data, which revealed previously overlooked abnormalities. This overlooked data delayed pulmonary embolism diagnosis, and the patient ultimately required bilateral pulmonary thromboendarterectomy. In this case, we describe the hallmark signs of pulmonary vascular disease seen during CPET and offer clinical pearls to aid in timely detection.