RISK FACTORS AND CLINICAL SIGNIFICANCE OF RESIDUAL PERFUSION DEFECTS AFTER SYMPTOMATIC PULMONARY EMBOLISM

Abstract Background Symptomatic pulmonary embolism (PE) after knee arthroscopy is extremely rare. If the embolism is not treated promptly, the patient may die. Bilateral pulmonary embolism with associated pulmonary infarct without concomitant deep vein thrombosis has never been reported following routine knee arthroscopy. Case presentation A 50-year-old female patient with no other risk factors other than hypertension, obesity, varicose veins in the ipsilateral lower extremities and elevated triglyceride (TG) presented to our ward. She had experienced sudden chest tightness, polypnea and fainting after going to the bathroom the morning of the second postoperative day and received emergency medical attention. Colour ultrasonography of the extremities showed no deep vein thrombosis. Lung computed tomography angiography (CTA) showed multiple embolisms scattered in both pulmonary artery branches. Thus, emergency interventional thrombolysis therapy was performed, followed by postoperative symptomatic treatment with drugs with thrombolytic, anticoagulant and protective activities. One week later, lung CTA showed a significant improvement in the PEs compared with those in the previous examination. Since the aetiology of PE and no obvious symptoms were discerned, the patient was discharged. Conclusion Although knee arthroscopy is a minimally invasive and quick procedure, the risk factors for PE in the perioperative period should be considered and fully evaluated to enhance PE detection. Moreover, a timely diagnosis and effective treatment are important measures to prevent and cure PE after knee arthroscopy. Finally, clear guidelines regarding VTE thromboprophylaxis following knee arthroscopy in patients with a low risk of VTE development are needed.

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Incidental Pulmonary Embolism Identified on Chest CT during Initial Trauma Evaluation

The American Surgeon ◽

10.1177/000313480807401202 ◽

2008 ◽

Vol 74 (12) ◽

pp. 1146-1148

Author(s):

Jean Marie Ruddy ◽

Nancy S. Curry ◽

E. Douglas Norcross ◽

Stuart M. Leon

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Case Report ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Clinical Significance ◽

Chest Ct ◽

Pulmonary Emboli ◽

Significant Morbidity ◽

Incidental Pulmonary Embolism

Deep venous thrombosis and pulmonary embolism frequently occur after trauma and continue to account for significant morbidity and mortality in this population. Asymptomatic pulmonary emboli are also believed to be quite common, but the incidence as well as the implications of these events is unknown. This case report describes two patients whose pulmonary emboli were found incidentally on the initial trauma workup. Very little has been written concerning this issue and in this case report we review the risk factors and clinical significance of these “incidentally discovered” pulmonary emboli.

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The Role of a Decision Rule in Symptomatic Pulmonary Embolism Patients with a Non-high Probability Ventilation-perfusion Scan

Thrombosis and Haemostasis ◽

10.1055/s-0038-1657630 ◽

1997 ◽

Vol 78 (02) ◽

pp. 794-798 ◽

Cited By ~ 2

Author(s):

Bowine C Michel ◽

Philomeen M M Kuijer ◽

Joseph McDonnell ◽

Edwin J R van Beek ◽

Frans F H Rutten ◽

...

Keyword(s):

Pulmonary Embolism ◽

Decision Rule ◽

Predictive Value ◽

Patient Population ◽

High Probability ◽

Characteristic Curve ◽

Stepwise Logistic Regression ◽

Pulmonary Angiogram ◽

Symptomatic Pulmonary Embolism ◽

Perfusion Scan

Summary Background: In order to improve the use of information contained in the medical history and physical examination in patients with suspected pulmonary embolism and a non-high probability ventilation-perfusion scan, we assessed whether a simple, quantitative decision rule could be derived for the diagnosis or exclusion of pulmonary embolism. Methods: In 140 consecutive symptomatic patients with a non- high probability ventilation-perfusion scan and an interpretable pulmonary angiogram, various clinical and lung scan items were collected prospectively and analyzed by multivariate stepwise logistic regression analysis to identify the most informative combination of items. Results: The prevalence of proven pulmonary embolism in the patient population was 27.1%. A decision rule containing the presence of wheezing, previous deep venous thrombosis, recently developed or worsened cough, body temperature above 37° C and multiple defects on the perfusion scan was constructed. For the rule the area under the Receiver Operating Characteristic curve was larger than that of the prior probability of pulmonary embolism as assessed by the physician at presentation (0.76 versus 0.59; p = 0.0097). At the cut-off point with the maximal positive predictive value 2% of the patients scored positive, at the cut-off point with the maximal negative predictive value pulmonary embolism could be excluded in 16% of the patients. Conclusions: We derived a simple decision rule containing 5 easily interpretable variables for the patient population specified. The optimal use of the rule appears to be in the exclusion of pulmonary embolism. Prospective validation of this rule is indicated to confirm its clinical utility.

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