Case Report: Acute pulmonary embolism complicating tracheobronchial tuberculosis: a case series of five patients

Background Tracheobronchial tuberculosis (TBTB) is a distinct airway-involving form of active tuberculosis, yet thromboembolic complications arising during its clinical course remain insufficiently characterized, whereas acute pulmonary embolism (PE) is a potentially life-threatening thromboembolic complication. The coexistence of TBTB and acute PE has rarely been reported, and its clinical features, diagnostic course, and management remain insufficiently described. Methods We retrospectively reviewed five consecutive adult patients with TBTB complicated by acute PE who were treated at Tianjin Haihe Hospital between December 2023 and August 2025. All patients had PE confirmed by computed tomography pulmonary angiography (CTPA), and TBTB was established on the basis of chest imaging, microbiological or molecular evidence of Mycobacterium tuberculosis in respiratory specimens, and bronchoscopic or pathological findings. Clinical characteristics, laboratory results, imaging and bronchoscopic findings, treatment patterns, and short-term outcomes were analyzed descriptively. Results The five patients included four women and one man, with a mean age of 77 years. PE was diagnosed 7–114 days after TBTB diagnosis (mean, 51 days), and all events occurred during ongoing anti-tuberculosis treatment. Dyspnea was the predominant presenting symptom in all patients, whereas chest pain, hemoptysis, fever, and marked hypoxemia were absent. D-dimer levels were elevated, but most inflammatory and cardiac injury markers were normal. CTPA showed bilateral multiple emboli in three patients, left-sided emboli in one, and right-sided emboli in one; one patient had involvement of the left main pulmonary artery. Four patients had bronchoscopy findings established before referral, and PE was identified during pre-procedural evaluation in most cases. All patients were hemodynamically stable and received immediate anticoagulation with low-molecular-weight heparin followed by rivaroxaban, together with individualized anti-tuberculosis therapy. No major bleeding events were observed during the available follow-up period. One patient developed minor old hemoptysis, and one developed elevated liver enzymes. Overall, the short-term clinical course was favorable, with no documented thrombus progression or death. Conclusion Acute PE may occur during the course of TBTB and can present with subtle and nonspecific manifestations, particularly unexplained dyspnea in otherwise stable patients. Early recognition is important because the coexistence of TBTB and PE may complicate diagnostic evaluation, bronchoscopic intervention planning, and anticoagulation during anti-tuberculosis treatment. These cases highlight the need for heightened clinical vigilance and multidisciplinary management in patients with TBTB who develop disproportionate respiratory symptoms during treatment.