Isolated Pulmonary Embolism following Shoulder Arthroscopy

Area of Science:

• Orthopedic Surgery
• Vascular Surgery
• Pulmonology

Background:

• Pulmonary embolism (PE) is a rare but serious complication following orthopedic procedures.
• Shoulder arthroscopy typically carries a low risk for thromboembolic events.

Purpose of the Study:

• To report a unique case of isolated pulmonary embolism (PE) occurring 41 days after shoulder arthroscopy.
• To highlight the diagnostic challenges and emphasize the importance of prompt evaluation in atypical presentations.

Main Methods:

• Case report presentation of a 43-year-old female with delayed PE post-shoulder arthroscopy.
• Diagnostic workup included pulmonary computed tomography (CT) angiography and extremity ultrasounds.
• Literature review was conducted to identify similar cases.

Main Results:

• The patient developed an acute PE in the right lower lobe 41 days post-surgery.
• No evidence of deep vein thrombosis (DVT) was found in the upper or lower extremities.
• The PE occurred in the absence of significant preoperative or intraoperative risk factors.

Conclusions:

• Isolated PE following shoulder arthroscopy, though rare, can occur without associated DVT.
• Sudden onset symptoms like hand swelling, dyspnea, and abdominal pain warrant aggressive investigation with pulmonary CT angiography.
• Clinicians should maintain a high index of suspicion for PE even with negative extremity ultrasounds.