Thivaharan Yalini, Dayapala Asurappulige, Thanushan Muthulingam
Colombo South Teaching Hospital, Kalubowila, Sri Lanka.
Department of Forensic Medicine, Faculty of Medicine, University of Sri Jayawardhanapura, Sri Jayawardhanapura, Sri Lanka.
Egypt J Forensic Sci. 2023;13(1):9. doi: 10.1186/s41935-023-00327-4. Epub 2023 Jan 23.
After substantial trauma, pulmonary embolism (PE) carries a high risk of morbidity and mortality. Early post-traumatic PE in the absence of deep vein thrombosis (DVT) is a distinct entity that might be connected to rare mechanisms or unidentified biochemical processes.
A driver of a car was presented with worsening chest pain and shortness of breath (SOB) following a road traffic accident in which he suffered an impact on the chest against the steering wheel and a closed fracture of the right femur. Radiological investigations revealed a pulmonary embolism in the left posterior segment pulmonary artery, without evidence of internal chest injuries or DVT within 12 h from the incident. D-dimer, troponin I, and creatinine kinase were elevated without evidence of myocardial infarction or myocardial injury. Other parameters were within the normal range.
Possibilities of early PE in the absence of detectable DVT could be due to hyper-coagulability states, clots from the lower extremity completely getting detached and embolizing to the pulmonary circulation, screening errors, and "de novo" thrombi in the pulmonary circulation. Chest trauma is an identified risk factor for early or late pulmonary embolism. Action of the post-traumatic adrenergic response causing vascular endothelial inflammation and the synthesis of circulating adhesion molecules leading to localized thrombosis have also been suggested as causes for this phenomenon. A greater understanding of rare risk factors for early PE and the possibility of rare complications of chest trauma is useful in detecting and treating them in time, reducing morbidity and mortality.
严重创伤后，肺栓塞（PE）具有较高的发病和死亡风险。在无深静脉血栓形成（DVT）的情况下发生的创伤后早期PE是一种独特的情况，可能与罕见机制或不明生化过程有关。
一名汽车司机在道路交通事故后出现胸痛和呼吸急促（SOB）加重，事故中他胸部撞到方向盘，右股骨闭合性骨折。放射学检查显示左肺后段肺动脉有肺栓塞，事故发生后12小时内无胸部内伤或DVT证据。D-二聚体、肌钙蛋白I和肌酸激酶升高，但无心肌梗死或心肌损伤证据。其他参数在正常范围内。
在无可检测到的DVT情况下发生早期PE的可能性可能归因于高凝状态、来自下肢的血栓完全脱落并栓塞到肺循环、筛查错误以及肺循环中的“新生”血栓。胸部创伤是早期或晚期肺栓塞的一个已确定的危险因素。创伤后肾上腺素能反应导致血管内皮炎症以及循环黏附分子合成导致局部血栓形成的作用也被认为是这种现象的原因。更好地了解早期PE的罕见危险因素以及胸部创伤罕见并发症的可能性有助于及时检测和治疗它们，降低发病率和死亡率。
