Varicose Vein Trauma: A Risk for Pulmonary Embolism
Published: October 1, 2014 | DOI: https://doi.org/10.7860/JCDR/2014/.5062
Parijat S Joy, Creticus P Marak, Anna M Ponea, Achuta K Guddati
1. Associate Phycisian, Department of Internal Medicine, University of Iowa Hospitals and Clinics, University of Iowa, Iowa, IA- 52242, USA.
2. Fellow Physician, Pulmonary and Critical care, Department of Medicine, Tahlequah City Hospital, Tahlequah, OK- 74464, USA.
3. Fellow Physician, Pulmonary and Critical care, Department of Medicine, Montefiore Hospital, Albert Einstein College of Medicine, Yeshiva University,
New York, USA.
4. Instructor, Department of Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Harvard University, Boston, MA 02114, USA.
Correspondence
Dr. Parijat S Joy,
Associate Phycisian, Department of Internal Medicine, University of Iowa Hospitals and Clinics,
University of Iowa, Iowa, IA- 52242, USA.
Phone: 267-979-8293, E-mail: joymedicine2@gmail.com
Pulmonary embolism (PE) is a deceptive condition which is often incorrectly diagnosed leading to high morbidity and mortality. We present a case where symptoms were localised to different areas of the body starting with post-traumatic pain over lower extremity varicosities that migrated sequentially over a month to the knee, hip, back, abdomen and chest finally presenting as syncope. Despite a low pre-test clinical probability, a very high index of suspicion led to a timely diagnosis of a massive bilateral PE that eventually caused a troponin leak. The aetiology is highly suspicious of a thrombus which originated in the veins of the leg due to trauma over varicose veins.The case described here exemplifies the importance of considering trauma to varicosities as a risk factor for embolism when the clinical picture is concerning but other signs and symptoms of PE are not apparent
[
FULL TEXT ] | [ PDF]