Acute Pulmonary Embolism in a 19-year-Old Male with Elevated Lipoprotein (a): A Rare Presentation in Early Adulthood

Abstract

Pulmonary embolism (PE) is uncommon in adolescents and young adults without recognised comorbidities or conventional thromboembolic risk factors. This report describes a 19-year-old male who presented with acute breathing difficulty and one episode of vomiting after recovering from a recent febrile illness. Electrocardiography showed sinus tachycardia and an S1Q3T3 pattern with right ventricular strain. Echocardiography demonstrated right ventricular dysfunction, reduced tricuspid annular plane systolic excursion, and pulmonary arterial hypertension, while computed tomography pulmonary angiography confirmed extensive bilateral emboli involving segmental and subsegmental branches, with significant right heart strain. Laboratory evaluation showed elevated D-dimer and brain natriuretic peptide levels, whereas troponin was normal. Lower-limb venous Doppler ultrasonography showed no evidence of deep vein thrombosis. The patient received systemic thrombolysis with tenecteplase, followed by enoxaparin and subsequent oral rivaroxaban, with favourable clinical recovery. Thrombophilia testing showed an elevated lipoprotein(a) concentration of 63.2 mg/dL, while homocysteine, free protein S antigen, protein C, antithrombin activity, and tested thrombophilic mutations were within normal limits or negative. This case demonstrates the diagnostic importance of considering PE in young patients with acute respiratory symptoms and signs of right heart strain. Elevated lipoprotein(a) may represent a contributing abnormality; however, its causal role in venous thromboembolism remains uncertain and requires cautious interpretation.