Abstract
We report a serious case of pulmonary thromboembolism (PTE) -a common post-orthopedic surgery complication-caused by prolonged casting. A long leg cast was applied in a 39-year-old man for Achilles tendon rupture on the right side. After approximately 3 weeks, he developed exertional dyspnea; a week later, he suddenly developed severe dyspnea at rest and required immediate hospitalization. The patient eventually developed tachypnea and experienced restlessness. We diagnosed PTE based on his condition and physical examination. He was intubated and placed on percutaneous cardiopulmonary support (PCPS) because of circulatory collapse. Thereafter, pulmonary arteriography was performed, and substantial emboli were detected in both pulmonary arteries. Therefore, catheter-directed fragmentation was performed, and standard anticoagulant therapy was administered. The patient's cardiopulmonary condition improved gradually; therefore, we discontinued PCPS and performed extubation. The Achilles tendon was sutured, and he was discharged 29 days after hospitalization. According to the American College of Chest Physicians (ACCP) guidelines, the need for thromboprophylaxis while casting lower limbs is controversial. Casting for Achilles tendon rupture results in PTE with almost the same frequency as that observed in elective hip replacement. Therefore, thromboprophylaxis or early surgical intervention should be considered while applying casts.
