• J Scott Baird, Anne Greene, and Charles L Schleien.
• Columbia University, College of Physicians and Surgeons, New York, USA.
• Pediatr Crit Care Me. 2005 Sep 1; 6 (5): 602-3.

ObjectiveTo describe a patient who had been taking ibuprofen for 3 days before the diagnosis of a massive pulmonary embolus without hypoxemia.DesignInstitutional review board-approved case report.SettingPediatric intensive care unit.PatientA 16-yr-old male with a history of supraventricular tachycardia.ResultsThe patient underwent an electrophysiology study and developed mild shortness of breath and then chest pain 2 and 4 days later, respectively. He took ibuprofen for 3 days. Evaluation 1 wk following the procedure revealed dyspnea and tachycardia. Arterial blood gas in room air was significant for hypocarbia without hypoxemia (Pao2, 108 mm Hg; Paco2, 28 mm Hg). Ventilation perfusion scan and computed axial tomography with intravenous contrast were consistent with a massive pulmonary embolus and left external iliac vein thrombus. He received anticoagulation, thrombolysis, a stent in the left iliac vein, and a filter in the inferior vena cava. Perfusion gradually improved and he was discharged home on oral anticoagulation.ConclusionsThe absence of hypoxemia (including a normal alveolar-arterial oxygen difference) in our patient with a massive pulmonary embolus may have been related to cyclooxygenase inhibition due to ibuprofen, with improvement in ventilation-perfusion mismatch.

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