Abstract
We report a case of successful management of pulmonary embolism (PE) after total hip arthroplasty (THA) in a 59-year-old woman.
PE developed 15 days after THA with the sudden onset of dyspnea and loss of consciousness. Based on the patient's history and clinical findings, such as complete right bundle branch block (RBBB) and right ventricular dilatation, we suspected PE and immediately started antithrombotic therapy in our ICU unit. On the next day, pulmonary scintigraphy showed wedge-shaped defects in both lung fields. Pulmonary arteriography revealed blockage of the main pulmonary artery at the level of its bifurcation into right and left pulmonary arteries. Deep venous thrombosis (DVT) of the right leg was confirmed by venography.
In order to treat the embolism, urokinase was injected through a catheter inserted into the pulmonary artery and heparin was also administrated intravenously. A filter was inserted into the inferior vena cava to prevent the recurrence of PE. After 4 days of intensive treatment, recanalization of the pulmonary artery was showen by pulmonary arteriography and the general condition gradually improved. The patient was discharged 64 days after the onset of PE for rehabilitation.
We conclude that immediate diagnosis and treatment of PE after THA can contribute to a good outcome.
