Symptomatic bilateral pulmonary embolism without deep venous thrombosis in an adolescent following arthroscopic anterior cruciate ligament reconstruction: a case report and review of the literature

• Main Authors: Jonathan Bourget-Murray, Mathew A. Clarke, Sydney Gorzitza, Lisa A. Phillips
• Format: Article
• Language: English
• Published: BMC 2018-07-01
• Series: Journal of Medical Case Reports
• Subjects: Pulmonary embolism (PE); Deep venous thrombosis (DVT); Knee arthroscopy; Thromboprophylaxis; Anterior cruciate ligament reconstruction
• Online Access: http://link.springer.com/article/10.1186/s13256-018-1726-8
• ISSN: 1752-1947

Abstract Background Venous thromboembolism, specifically pulmonary embolism, is a rare complication following elective pediatric orthopedic surgery. Bilateral pulmonary embolism with associated pulmonary hemorrhage/infarct without concomitant deep vein thrombosis has never been reported following routine anterior cruciate ligament reconstruction in an adolescent. Case presentation A 16-year-old white girl presented with acute onset shortness of breath and pleuritic chest pain 6 days following elective anterior cruciate ligament reconstruction. After performing a thorough work-up, she was diagnosed as having provoked bilateral pulmonary embolism with associated pulmonary hemorrhage without concomitant deep vein thrombosis. She was treated successfully with 3 months of anticoagulation therapy with daily Lovenox (enoxaparin) injections. Conclusions Symptomatic bilateral pulmonary embolism may have a good prognosis if it is diagnosed early and treated appropriately. It is important to appreciate the risk of provoked thromboembolic events in healthy adolescents undergoing arthroscopic knee surgery.