S25 

A Healthy Young Lady with ‘Unprovoked’ Persistent Bilateral Pulmonary Embolism - Why? 
 

Dr Muhammad Farid bin Mohd Fauad1, Dr Hazlyna Baharuddin1, Dr Mohd Arif Mohd Zim1,  

Dr Bushra Johari1 

 

 

Abstract 

 

Pulmonary embolism (PE) was reported in about 9% patients with antiphospholipid syndrome 

(APS). Seronegative APS is an entity which demonstrates clinical manifestations highly 

suggestive of APS but persistently negative APS antibodies. A 31-year-old lady presented with 

a two-month history of exertional dyspnoea. She had two consecutive miscarriages at 12 and 

14 weeks, previously. Physical examination revealed a thin lady who was tachycardic, 

tachypneic, hypoxic but normotensive. There was a loud P2 without signs of heart failure. 

Investigations revealed a type 1 respiratory failure, sinus tachycardia with right ventricular 

strain pattern, cardiomegaly with normal lung fields, and dilated right atrium and right ventricle 

with increased in pulmonary arterial pressure of 70mmHg from echocardiography. CT 

pulmonary angiography (CTPA) confirmed the presence of PE over bilateral pulmonary 

arteries. She continued to have exertional dyspnoea and was readmitted 9 months later with 

worsening dyspnoea. APS antibodies performed during both admissions were negative. 

Seronegative APS was diagnosed. Interestingly, two CTPAs performed at 6 months and 9 

months after initial presentation revealed persistent bilateral pulmonary embolism. The 

provoking factors for PE should be sought because ‘unprovoked’ PE especially in young 

individuals need further attention. APS, including seronegative APS, should be considered. 

Persistence of symptoms of PE also warrants further attention as chronic thromboembolic 

pulmonary hypertension (CTEPH) may be the cause. Currently, there are available medical 

and surgical treatment of CTEPH, therefore establishing its diagnosis is important and it is best 

performed in pulmonary hypertension expert centre. 

Keywords: Pulmonary embolism; seronegative anti-phospholipid antibodies, chronic 

thromboembolic pulmonary hypertension (CTEPH) 

 

1. Department of Internal Medicine, Faculty of Medicine, Universiti Teknologi Mara 

  

DOI: http://dx.doi.org/10.31344/ijhhs.v5i0-2.343  
 

http://dx.doi.org/10.31344/ijhhs.v5i0-2.343