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Nakamura, K., Tachibana, S., Fuji, T., Akagi, M., Abe, Y., Ikeda, N., Ishii, S., Kobayashi, S., Sato, T., Nakamura, S., Higuchi, F., Fujita, S. and Yanagimoto, S. (2008) Japanese Orthopaedic Association (JOA) Clinical Practice Guideline on the Prevention of Venous Thromboembolism in Patients Undergoing Orthopaedic Treatments. 1. Nankodo, Tokyo. (In Japanese)

has been cited by the following article:

• TITLE: Pulmonary Embolism after Bilateral Upper Limb Surgeries: A Case Report and Review of Literature

  AUTHORS: Mujeeb Rohilla, Mohammad Waseem Beeharry, Gurudat Sisodia

  KEYWORDS: CT Pulmonary Angiogram, D-Dimer, Deep Vein Thrombosis, Pulmonary Embolism, Ultrasound

  JOURNAL NAME: Surgical Science, Vol.10 No.10, October 15, 2019

  ABSTRACT: Pulmonary embolism following upper limb surgery is a very rare complication. Here we present a unique case report of a 54-year-old young, fit and healthy, and non-smoker male who developed bilateral pulmonary embolism (PE) 26 days post-operatively with no associated upper or lower limb Deep Vein Thrombosis (DVT). This patient had minimal preoperative as well as intra-operative risk factors. He did not develop any thromboembolic symptoms until the 26th-day post-surgery when he developed sudden, sharp, pleuritic chest pain and laboured breathing. Initial baseline bloods showed a raised D-Dimer and the patient subsequently had a CT pulmonary angiogram that confirmed the presence of bilateral massive PEs. However, subsequent extremity ultrasound showed no upper or lower deep venous thrombosis. Thorough review of literature suggests that sudden development of PEs after upper limb surgery is possible, with a few cases being reported in the past. Symptoms such as sudden upper limb swelling, troubled breathing and systemic symptoms should be evaluated aggressively with a CT pulmonary angiogram, given the fact that an ultrasound of the extremities may be negative for deep venous thrombosis.