Pulmonary thromboembolism with pulmonary tuberculosis

Out of 77 patients who were admitted to our hospital because of pulmonary tuberculosis from January 2007 to October 2009, 3 patients (3.9%) suffered from pulmonary thrombotic embolism (PTE) and/or deep venous thrombosis (DVT). Case 1: An 80-year-old male with elevated D-dimer was diagnosed with PTE on the basis of an enhanced chest CT showing filling defects in the bilateral pulmonary arteries. Case 2: A 39-year-old male presented with prolonged high-grade fever even after administration of anti-tuberculosis drugs and complained of weakness. His D-dimer was high on admission and became still higher; then, edema was found on his left lower limb, and he was diagnosed with DVT on the basis of lower limb ultrasonography showing isoechoic thrombosis from the IVC to the left popliteal vein. An IVC filter was needed to treat his lesion. Case 3: A 69-year-old female with elevated D-dimer and edema on the right lower limb was diagnosed with PTE and DVT on the basis of chest CT findings. Since anti-coagulation therapy could not be continued due to intestinal bleeding, an IVC filter was placed. All 3 cases presented with no dyspnea and two of the three cases showed no hypoxemia. Even in cases of pulmonary tuberculosis without dyspnea, D-dimer seems to be useful for the early diagnosis of thromboembolism.