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Suffering from face inflation. CT chest angiography done. Suspected for pulmonary embolism. Second opinion?

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My father has been suffering from face inflation and pressure since the last 6 months. This problem is more prominent when he wakes up from sleep in morning or while taking bath. His CT Chest Angiography report says the following:

"Severe focal stenosis is seen in SVC at level of azygos vein. Pacemaker leads are seen in SVC. Dilated azygos and hemiazygos system seen"

Some dr. are saying that it can be " Pulmonary embolism" but i searched in google where Pulmonary embolism has some symptoms like --chest pain, shortness of breath, anxiety, and cough etc. but my father doesnot have any one of this ..
So what is the disease for that my father is suffering? and what can be the treatment ? is there any life risk in this case??

Posted Sun, 14 Apr 2013 in Hypertension and Heart Disease
Answered by Dr. Anantharamakrishnan 11 hours later
Hi friend,
Welcome to Health Care Magic

Pulmonary embolism is a very XXXXXXX complication and it is difficult to diagnose with certainty, in most cases. Therefore, in an expectant situation, treatment is started on suspicion alone / waiting for confirmation may end up in disastrous consequences / it is also costly and time consuming and not fool proof.

In a setting of venous thrombosis (here it is in the SVC), the following features (individually or in combination) suggest embolism and warrant treatment. They include unexplained rise in heart rate or arrhythmia like SVT or A-fib / ECG changes like right ventricular strain, RBBB, S1-Q3-T3 which may be transient / unexplained dyspnoea / pleural pain or effusion (may be haemorrhagic) / fall in SpO2 level (oxygen saturation) / some alteration in blood gases / blood tests like D-dimer, FDP and so on so forth...
High Resolution CT during the early hours may confirm.
V/Q study (Ventilation- Perfusion scan) is the gold standard, but it is time dependent / involves radioactivity / risk of transport and prolonged time. Yet, it could be inconclusive or difficult to interpret in some cases.
In summary, it is often the clinical judgement / sudden change of parameters - that leads to diagnosis and management.
The ideal person to advise is the doctor at the bed side / site – discuss with him. He will be able to guide further...

Take care
Wishing speedy recovery
God bless
Good luck
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