Presentation
Left leg pain and dyspnea one week following left knee reconstruction. Extensive left lower limb deep vein thrombosis identified on ultrasound extending from popliteal to common iliac vein.
Patient Data
Large bilateral central pulmonary emboli extending from the lateral aspects of the right and left pulmonary arteries into lobar branches. On the right, there is a 4.2 cm length of clot extending from the right pulmonary artery into the right lower lobe branch and on the left a 2.8 cm length of clot in the left lateral pulmonary artery extending into the lower lobe. Further emboli are seen in the upper lobes right middle and left lingular segmental branches.
There is straightening of the intraventricular septum suggesting that there is right heart strain present. Minor dependent change seen in the lungs bilaterally.
Case Discussion
This 50-year-old female presented with signs and symptoms of deep vein thrombosis (DVT) in her left leg, provoked by recent orthopedic surgery. She was obese, an ex-smoker and had polycystic ovarian syndrome; however, no history of venous thromboemboli or clotting disorders. No family history of venous thromboemboli.
Of significant note, she was not put on any mechanical or pharmacological DVT prophylaxis post-operatively. Her physiotherapist noticed left calf swelling and erythema so sent her for a lower limb ultrasound, which confirmed extensive above-knee DVT. The patient had a complaint of dyspnea that same day so was sent to the emergency department where she underwent CTPA. She was haemodynamically stable throughout and did not receive any thrombolysis. She was therapeutically anticoagulated and made a good recovery.
Unable to process the form. Check for errors and try again.