A 38-year-old man in Nanjing, China, was rushed to hospital after a seven-hour drive without stopping left him with severe chest and back pain — eventually leading to a diagnosis of acute bilateral pulmonary embolism.
The man, identified by the surname Jiang, had driven back to Nanjing from another city without taking a break. Shortly after arriving home, he developed swelling and pain in both legs, followed by pain on the right side of his back.
Initially believing the symptoms were simply muscle soreness from the long drive, Jiang did not seek medical attention. The following day, however, he began experiencing chest discomfort while working and climbing stairs, although he felt relatively normal when walking on level ground.
He expected another day of rest would help, but his condition deteriorated that night. While lying down, he suddenly developed severe chest and back pain accompanied by worsening breathlessness. His family immediately took him to the emergency department, where doctors diagnosed him with acute, intermediate-to-high-risk bilateral pulmonary embolism, a potentially life-threatening vascular emergency.
Jiang was quickly transferred to the hospital’s interventional vascular department. A team led by department director and chief physician He Xu assessed his condition and opted for minimally invasive thrombectomy to rapidly remove the blood clots, restore blood flow through the pulmonary arteries and relieve his symptoms.
He explained that venous thromboembolism (VTE) includes deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE), commonly known as pulmonary embolism. They are different manifestations of the same condition, with prolonged bed rest and extended periods of sitting or standing among the major risk factors. He added that cases have also been increasing among younger and middle-aged adults.
DVT commonly develops in the lower limbs and may initially cause only mild swelling, aching or numbness, making it easy to mistake the symptoms for ordinary fatigue. However, a clot can break loose when a person gets up and moves around, with the calf muscles potentially contributing to its movement through the bloodstream towards the lungs.
If the clot reaches the pulmonary arteries, it can cause a pulmonary embolism. Mild cases may cause chest tightness and shortness of breath, while severe blockages can significantly restrict blood flow through the lungs and potentially lead to sudden death.
Pulmonary embolism is often described as a “silent killer” because symptoms can be difficult to recognise and the condition can progress rapidly. Depending on its severity, patients may experience persistent breathlessness, chest pain or coughing up blood. Without timely treatment, severe cases can result in shock, impaired consciousness or cardiac and respiratory arrest.
With the National Day holiday underway, He urged people travelling by car, high-speed rail or plane to be mindful of the risks associated with prolonged sitting. Long periods of inactivity can slow blood circulation in the legs and increase the risk of venous thrombosis, while a detached clot can travel to the lungs and cause a pulmonary embolism — commonly associated with what is known as “economy class syndrome”.
For long-distance journeys, travellers should get up and move around for five to 10 minutes every one to two hours whenever possible. When getting up is not practical, movements such as flexing the ankles, raising the heels and lifting the legs can help activate the calf muscles and promote blood circulation.
He also advised travellers to stay adequately hydrated, avoid prolonged sleep deprivation and excessive fatigue, and maintain regular exercise as part of efforts to reduce the risk of blood clots.
