Ahammed Shabeer Thalackal: A Case That Reinforced the Power of Good History Taking
Ahammed Shabeer Thalackal, General Practitioner at Aster Hospitals UAE, shared on LinkedIn:
”ER Encounters (De-identified) | N 02
A Case That Reinforced the Power of Good History Taking:
A 30-year-old woman presented to the ER with fever, right-sided chest pain, and cough for two days.
At first glance, it appeared to be a routine respiratory infection—until careful history taking shifted the entire clinical direction.
On focused questioning, she reported three episodes of hemoptysis and intermittent shortness of breath.
Her ECG showed sinus tachycardia with an S1Q3T3 pattern, raising immediate concern.
Detailed history revealed key risk factors:
Past history of calf swelling 6 months ago, self-limited, with no medical evaluation or treatment
Frequent long-distance travel, including a recent prolonged flight due to delays
Initial investigations, including troponin, were unremarkable. However, the D-dimer was elevated.
Wells Score for Pulmonary Embolism:
-Clinical signs suggestive of DVT → 3 points
-PE more likely than alternative diagnosis → 3 points
-Hemoptysis → 1 point
-Recent immobilization (long flight) → 1.5 points
Total Wells Score: 8.5 (High probability)
This justified immediate imaging with CT Pulmonary Angiography (CTPA).
CTPA confirmed pulmonary embolism:
-Thrombus in the distal right main pulmonary trunk with lobar and segmental branch involvement
-Eccentric thrombus in the distal left main pulmonary trunk
-Lower lobar thrombosis
-Mild right pleural effusion
-Right lower lobe consolidation
-Subsegmental atelectasis
She was admitted to the ICU, initiated on LMWH, and made a complete recovery.
Key Takeaways:
-Meticulous history can uncover silent thromboembolic risk
-Self-resolving symptoms may represent missed pathology
-Risk scores support—but never replace—clinical judgment in the ER
Grateful to the pulmonology and critical care teams for swift collaboration and definitive management.
ER Encounters (De-identified)
Real emergency cases. Anonymous. Academic. Shared for learning and reflection.”
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