Abstract
IntroductionFatal pulmonary embolism following a shoulder joint replacement is a rare event. The exact prevalence of shoulder arthroplasties is not clear. Unlike hip and knee joint replacements where some form of thromboprophylaxis is routinely prescribed, no such guidelines and practice exist for shoulder replacements. Other case reports have confirmed fatal and non-fatal pulmonary embolisms following shoulder replacements, but particular risk factors were identifiable in those patients.Case presentationWe report the case of a 73-year-old Caucasian woman with fatal pulmonary embolism secondary to a calf deep vein thrombosis following a shoulder joint replacement procedure. The patient was otherwise healthy; there were no other risk factors directly contributing to deep vein thrombosis and pulmonary embolism except for a body mass index of 34. Post-mortem examination confirmed that the patient had a thrombus in the calf and a pulmonary embolus.ConclusionsFatal deep vein thrombosis and pulmonary embolism can occur following shoulder joint replacements in otherwise normal patients. A high degree of suspicion should therefore be maintained in susceptible individuals. Thromboprophylaxis needs careful consideration in shoulder replacements in susceptible individuals.
Highlights
Fatal pulmonary embolism following a shoulder joint replacement is a rare event
Other case reports have confirmed fatal and non-fatal pulmonary embolisms following shoulder replacements, but particular risk factors were identifiable in those patients
Case presentation: We report the case of a 73-year-old Caucasian woman with fatal pulmonary embolism secondary to a calf deep vein thrombosis following a shoulder joint replacement procedure
Summary
Deep vein thrombosis and pulmonary embolism (DVT/PE) are recognized complications of hip and knee joint replacements. Case presentation A 73-year-old Caucasian woman was admitted for elective shoulder replacement for an arthritic shoulder She was being treated for hypertension with beta-blockers and thiazide diuretics and her blood pressure was well controlled. She had a history of diverticulitis and varicose vein surgery with an uneventful outcome Her body mass index (BMI) was 34 during pre-operative anesthetic evaluation. The patient was already feeling well on the postoperative day and her blood parameters were satisfactory. Her pain was well controlled and her arm continued to be immobilized by the sling. While being monitored she suddenly became breathless, hypoxic and hypotensive and experienced intense sweating She did not complain of chest pain and an ECG was negative for cardiac ischemic changes. A post-mortem examination was requested, which confirmed pulmonary embolism and left calf deep vein thrombosis
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