Duan Y, Wang GL, Guo X, Yang LL, Tian FG. Acute pulmonary embolism originating from upper limb venous thrombosis following breast cancer surgery: Two case reports. World J Clin Cases 2022; 10(21): 7445-7450 [PMID: 36157985 DOI: 10.12998/wjcc.v10.i21.7445]
Corresponding Author of This Article
Fu-Guo Tian, Doctor, Chief Doctor, Breast Diagnosis and Treatment Center, Shanxi Provincial Cancer Hospital, No. 3 Zhigong New Street, Taiyuan 030013, Shanxi Province, China. 387769340@qq.com
Research Domain of This Article
Peripheral Vascular Disease
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jul 26, 2022; 10(21): 7445-7450 Published online Jul 26, 2022. doi: 10.12998/wjcc.v10.i21.7445
Acute pulmonary embolism originating from upper limb venous thrombosis following breast cancer surgery: Two case reports
Yan Duan, Guo-Li Wang, Xin Guo, Li-Li Yang, Fu-Guo Tian
Yan Duan, Guo-Li Wang, Xin Guo, Li-Li Yang, Department of Critical Care Medicine, Shanxi Provincial Cancer Hospital, Taiyuan 030013, Shanxi Province, China
Fu-Guo Tian, Breast Diagnosis and Treatment Center, Shanxi Provincial Cancer Hospital, Taiyuan 030013, Shanxi Province, China
Author contributions: Wang GL, Guo X, and Yang LL were the patient’s doctors, reviewed the literature, and contributed to manuscript drafting; Duan Y reviewed the literature and contributed to manuscript drafting; Tian FG was responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors report no relevant conflict of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fu-Guo Tian, Doctor, Chief Doctor, Breast Diagnosis and Treatment Center, Shanxi Provincial Cancer Hospital, No. 3 Zhigong New Street, Taiyuan 030013, Shanxi Province, China. 387769340@qq.com
Received: September 25, 2021 Peer-review started: September 25, 2021 First decision: March 23, 2022 Revised: March 31, 2022 Accepted: June 15, 2022 Article in press: June, 15, 2022 Published online: July 26, 2022 Processing time: 288 Days and 19.1 Hours
Abstract
BACKGROUND
Upper limb venous thrombosis (ULVT) is rarer than lower-extremity deep venous thrombosis, and is related to Paget-Schroetter syndrome, central venous catheterization, and malignancy. There are few reports of pulmonary embolism (PE) from upper-extremity vein thrombosis due to surgery. Herein, we report two cases of PE that originated from upper limb venous thrombosis on the surgical side in two patients undergoing modified radical mastectomy for breast cancer. These cases challenge the traditional theory that PE originate only from the lower extremities.
CASE SUMMARY
We describe two female patients, aged 68 and 65 years, respectively, who had undergone modified radical mastectomy for breast cancer. They did not have a central venous catheter and did not undergo preoperative neoadjuvant chemotherapy. They were transferred to the intensive care unit due to symptomatic PE on the first day after surgery. Colour Doppler ultrasound identified fresh thrombosis in their upper limb veins, which was the presumed source of the PE. They all received anticoagulation therapy, and one of them experienced bleeding that required discontinuation of the drug. Ultimately, they were discharged in stable condition.
CONCLUSION
ULVT as a source of PE after breast cancer surgery cannot be ignored.
Core Tip: We report two cases of pulmonary embolism (PE) that originated from upper limb venous thrombosis (ULVT) on the side undergoing modified radical mastectomy for breast cancer. Our findings should spur surgeons to pay more attention to upper limb venous thrombosis. These cases challenge the traditional theory that PE originates from the lower extremities. Although there is a lower incidence of clinical PE in patients with upper limb venous thrombosis, since PE is a serious complication that can be potentially life-threatening, ULVT as a source of PE after breast cancer surgery cannot be ignored.
