Madhusudhan Thayur R, Shetty Sanath K, Madhusudhan Savitha, Sinha Amit
J Med Case Rep. 2009 Jul 31;3:8708. doi: 10.4076/1752-1947-3-8708.
Fatal 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.
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. 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.
Fatal 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.
肩关节置换术后发生致命性肺栓塞是一种罕见事件。肩关节置换的确切发生率尚不清楚。与髋膝关节置换不同，髋膝关节置换通常会常规开具某种形式的血栓预防措施，而肩关节置换则没有此类指南和做法。其他病例报告证实了肩关节置换术后发生致命性和非致命性肺栓塞，但在这些患者中可确定特定的危险因素。
我们报告一例73岁白人女性病例，该患者在肩关节置换术后因小腿深静脉血栓形成继发致命性肺栓塞。该患者其他方面健康；除体重指数为34外，没有其他直接导致深静脉血栓形成和肺栓塞的危险因素。尸检证实患者小腿有血栓和肺栓塞。
在其他方面正常的患者中，肩关节置换术后可能发生致命性深静脉血栓形成和肺栓塞。因此，对易感个体应保持高度怀疑。对于易感个体的肩关节置换，需要仔细考虑血栓预防措施。
