Recurrent, massive pulmonary embolism in chronic myelopathy: a case report.

STUDY DESIGN

Case report.

OBJECTIVES

The aim of this report was to describe an example of pulmonary embolism (PE), recently suggested to be highly prevalent in persons with chronic spinal cord lesions.

SETTING

Veterans Affairs Hospital, Boston, MA, USA.

METHODS

Chart review.

RESULTS

A 60-year-old man with paraplegia, T10 motor complete, underwent laminectomy for correction of an arteriovenous malformation. After 41 days, he sustained a massive PE-suggested by right bundle branch block (RBBB) on an electrocardiogram (ECG) and diagnosed by perfusion lung scanning. He was treated with anticoagulants, the lung scan and RBBB resolving within 1 month of initiating treatment. After 5 years, he developed vertebral osteomyelitis at L5-S1 and was treated with antibiotics and bed rest. After 7 days, he was mobilized to a wheelchair, and during a transfer back to bed, he developed anxiety, dyspnea, fluctuating consciousness, low blood pressure and RBBB, absent by ECG 4 days earlier. He expired 20 min after onset of symptoms. The autopsy revealed a fresh thromboembolus occluding both main stem branches of the pulmonary artery.

CONCLUSION

Massive PE after surgery in a patient with chronic paraplegia recurred 5 years later in association with severe infection and mobilization after bed rest, which resulted in death.