Bilateral pulmonary emboli in an amateur kick boxer: A case
Here, authors present a 16-year-old male athletic adolescent who developed a large bilateral pulmonary embolism after blunt trauma to the chest during a kickboxing class.

A 16-year-old male athlete presented to the emergency department with a 2-h history of pleuritic left chest pain after blunt trauma to the chest during a kickboxing training session 4 days prior to the presentation. On arrival at the hospital, he was tachycardic at 115/min, blood pressure was 119/68 mmHg, respiratory rate was 21/min, oxygen saturation was 98% on room air and temperature was 38°C, the rest of physical examination was unremarkable.

Chest radiography showed opacity in the left lower lung zone with evidence of small effusion, however, no evidence of rib fracture.

CT chest showed ‘left lower lobe opacities that was thought to be related to lung contusion/alveolar hemorrhage’. He was admitted with community-acquired pneumonia for 2 days, treated with antibiotics, and was discharged home.

At home, his condition worsened, and he had started to experience severe chest pain. He denied pain or swelling of his lower limbs, he denied extended periods of immobilization, recent surgery, use of anabolic steroids, current or past history of malignancy, constitutional symptoms or family history of thrombophilia or recurrent pregnancy loss. Three days after discharge, he presented to a primary hospital with hemoptysis. Physical exam was significant for tachypnea at 30 respirations/min.

Repeated CT chest showed Bilateral PE with pulmonary infarction. The CT scans were reviewed with a senior radiologist and he noted the presence of an early PE on the initial CT scan. He also noted a large lymph node (8 mm). Doppler ultrasonography of lower limb showed patent venous system with no evidence of deep vein thrombosis.

Because of the enlarged Lymph node on the CT thorax, we investigated for underlying lymphoma as the underlying cause of PE, despite the absence of the usual clinical features. However, a CT of his abdomen did not reveal any evidence of lymphadenopathy or organomegaly. Thrombophilia workup was negative.

He was treated with subcutaneous enoxaparin then switched to warfarin with uneventful hospital course. He completed 3 months of anticoagulation after which a thrombophilia workup was negative.