Two Case Report of Early Pulmonary Thromboembolism after Injury

Jin, Sang Chan; Choi, Woo Ik

Abstract

Pulmonary embolism (PE) is generally thought to occur between days 5 to 7 after acute injury. However, PE can occur early after injury and the features of early PE after injury have not been well studied. We report on two cases of acute PE within two days after thoracic and lower extremity injury. First, a 39-year-old female presented to the emergency department complaining of chest pain and dyspnea. Fifteen hours earlier, she had fallen from a 1 m height drawer at home. She had a history of idiopathic pulmonary arterial hypertension. Initial blood pressure was normal; however, oxygen saturation was 83% on room air. Chest computerized tomography (CT) showed a low density filling defect in the left main pulmonary artery. However, no deep vein thrombus was observed on low extremity CT angiogram. Second, a 21-year-old male was transferred from a local clinic to the emergency department. He had pelvic ramus, right femur shaft and ankle fracture from a motorcycle accident, which had occurred 36 hours ago. Initial vital signs were stable and he had no symptoms related to PE, except leg pain. We performed CT scan in order to rule out injury associated with pelvic bone fracture. CT scan showed filling defects in the segmental pulmonary artery of the left lower lobe. We did not find deep vein thrombus on low extremity CT angiogram. PE related to trauma can occur in early days after injury and is not commonly associated with deep vein thrombus. Emergency physicians should consider PE in the differential for patients with unexplained dyspnea, even early after injury.