Large hiatal hernia as a risk factor for recurrent pulmonary embolism in a 76-year-old female patient

Introduction: Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a serious public health problem. Each hospitalized patient should be assessed for the risk of thrombosis. However, it should be noted that in some cases patients may have rare risk factors which may not be known at the initial assessment stage. Material and methods: The purpose of this paper was to present a case report of a 76-year-old female patient with a second episode of PE, who had a rare risk factor in the form of extensive hiatal hernia (HH) causing pressure on the pulmonary arteries. Results: A 76-year-old patient was admitted to the Clinic as part of the emergency service due to dyspnoea that had been increasing for three days and fainting. For approximately a week, the patient stopped taking previously recommended medications, including anticoagulant treatment initiated due to PE diagnosed two months earlier. As a result of the diagnostic tests, a second episode of intermediate-risk PE associated with a massive HH was diagnosed. Conclusions: A large HH is a rare but important factor that may lead to an increased risk of PE occurrence due to compression of the pulmonary arteries, especially if it coexists with a significant deepening of thoracic kyphosis, which is associated with an additional increase in mediastinal tightness.