Caution for acute submassive pulmonary embolism with syncope as initial symptom: a case report

Pulmonary embolism (PE) may escape prompt diagnosis since clinical symptoms and signs are nonspecific. The occurrence of syncope as the sole initial symptom in a previously healthy patient with no predisposing factors to embolism and no hemodynamic instability is extremely rare, which may have been a factor in the delayed diagnosis. We describe a case of acute submassive PE with syncope as the initial symptom. A 62-year-old previously healthy female was admitted to our hospital for transitory episode of syncope. Following admission, chest computed tomography demonstrated embolism in the right main pulmonary and left inferior pulmonary arteries. Following the final diagnosis, the patient was successfully treated with thrombolytic therapy with systemic urokinase. We consider that raised awareness and early diagnosis and treatment were key factors in ensuring a satisfactory prognosis.