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.