We report a patient with symptomatic pulmonary embolism (PE) who developed on the first postoperative day of total knee arthroplasty (TKA), which was attributable to deep vein thrombus (DVT) formed during the surgery. The patient was a 70-year-old woman and at high risk for DVT/PE because she had developed DVT after arthroscopic debridement 3 years earlier and developed symptomatic PE after bone biopsy one year before the present right TKA. Ultra-sonographic (US) examinations performed immediately before and after the surgery demonstrated proximal type deep venous thrombus continuing from the soleal vein to the popliteal vein in the ipsilateral leg. On the first day after the surgery, under administration of dose-adjusted unfractionated heparin, the patient developed symptomatic but not fatal PE with chest pain and dyspnea, which was diagnosed by enhanced CT scans of pulmonary arteries. Repetitive US demonstrated disappearance of the thrombus, suggesting that it moved to the lung as emboli. This case illustrates that PE developing early postoperatively is attributable to deep vein thrombi formed intraoperatively. Prevention against DVT/PE should be indicated considering intraoperative formation of deep vein thrombi and possible development of PE immediately after the surgery.
