Fatal dyspnea in a patient with renal failure

A 67-year-old woman with hypertension, diabetes, hypothyroidism and chronic renal failure reported to the hospital for her regularly scheduled hemodialysis, complaining of shortness of breath. Despite fluid removal during her hemodialysis, she remained tachypneic and developed stridor. She was admitted to the hospital for a work-up of a known mediastinal mass, thought to be a goiter. However, she deteriorated over the next several hours and expired. A post-mortem examination confirmed fatal pulmonary emboli. This case illustrates the fact that, while most patients with chronic renal failure are considered to be at low risk for pulmonary emboli, it is often not diagnosed when present. In this paper, we will review the epidemiological data supporting this notion, examine proposed pathophysiological mechanisms, and review the diagnostic approach that should be considered in the setting of chronic renal failure.