# “Complication unveiled: Bilateral pulmonology embolism in the wake of shoulder arthroplasty” a case report

## TL;DR

This case report describes a rare but serious complication of bilateral pulmonary embolism following shoulder replacement surgery, highlighting the need for better prevention strategies.

## Contribution

The paper reports a rare case of bilateral pulmonary embolism after shoulder arthroplasty and identifies risk factors and prevention strategies.

## Key findings

- Bilateral pulmonary embolism is a rare but potentially fatal complication following shoulder arthroplasty.
- CT pulmonary angiography is the gold standard for diagnosing bilateral pulmonary embolism.
- Prophylactic anticoagulation and early mobilization are critical in reducing the risk of pulmonary embolism.

## Abstract

Most common cases of Venous thromboembolism (VTE) seen for those who underwent for lower limb reconstruction and orthopedic trauma surgery in general. VTE was a rare surgical complication after shoulder replacement surgery. This study highlights that pulmonary embolism following upper extremity surgery increased in prevalence without currently guidelines for thromboembolism prevention during upper extremity surgeries especially shoulder arthroplasty surgeries.

80-year-old female patient presented at clinic with right shoulder pain. Clinical features and radiological investigations were suggestive of rotator cuff arthropathy. Following the diagnosis, the patient underwent right shoulder reverse arthroplasty. Two days post operation, the patient exhibited confusion and a decline in consciousness level also decrease in oxygen saturation levels. Clinical features and investigations pointed towards acute pulmonary embolism as the cause of the symptoms. Prompt intervention was initiated, and the patient was started on anticoagulant therapy to manage the condition. With appropriate management, the patient stabilized and was discharged from the hospital.

Diagnosis of PE need detailed history and physical examination including vital signs and modality of imaging like spiral Computed Tomography scan, risk factors for pulmonary embolism in patients who underwent shoulder arthroplasty were old age, prolonged surgery, female gender, obesity, diabetes, fluid and electrolyte imbalances, prolonged surgery and undergoing shoulder arthroplasty.

prophylactic anticoagulant therapy should be considered in patients with Risk factor for pulmonary embolism. There is a need to implement strategies, relevant guidelines, and policies to manage high-risk cases with a suspicion of thromboembolism post-shoulder arthroplasty.

•Rare Complication: Bilateral pulmonary embolism is a rare but potentially fatal complication following shoulder arthroplasty.•Risk Factors Identified: Pre-existing conditions such as obesity, prolonged immobility, and history of thromboembolism increase the risk.•Diagnostic Tools: CT pulmonary angiography is the gold standard for diagnosing bilateral pulmonary embolism.•Prevention Strategies: Prophylactic anticoagulation and early mobilization are critical in reducing the risk.

Rare Complication: Bilateral pulmonary embolism is a rare but potentially fatal complication following shoulder arthroplasty.

Risk Factors Identified: Pre-existing conditions such as obesity, prolonged immobility, and history of thromboembolism increase the risk.

Diagnostic Tools: CT pulmonary angiography is the gold standard for diagnosing bilateral pulmonary embolism.

Prevention Strategies: Prophylactic anticoagulation and early mobilization are critical in reducing the risk.