# Simultaneous Pneumothorax and Pulmonary Embolism With Concurrent COVID-19 After Shoulder Arthroscopy: A Case Report

## TL;DR

A 72-year-old woman developed pneumothorax, pulmonary embolism, and COVID-19 after shoulder surgery, highlighting diagnostic and treatment challenges.

## Contribution

The paper presents a rare case of three concurrent postoperative complications and emphasizes diagnostic and management lessons.

## Key findings

- Pneumothorax and pulmonary embolism can coexist after shoulder arthroscopy, complicating diagnosis.
- Persistent hypoxemia after pneumothorax drainage should prompt early contrast-enhanced CT.
- Minimizing operative time and considering alternative procedures may prevent complications in high-risk patients.

## Abstract

Shoulder arthroscopy is generally safe; however, pneumothorax and pulmonary embolism can rarely occur, and their coexistence poses substantial diagnostic challenges. We report a case in which both developed after arthroscopic surgery, together with concurrent COVID-19 infection.

A 72-year-old woman sustained an anterior shoulder dislocation with rotator cuff tears and a large bony Bankart lesion. She underwent arthroscopic Bankart and cuff repair 20 days after injury. On postoperative day (POD) 2, a pneumothorax was detected and treated with chest drainage; however, hypoxemia persisted. Contrast-enhanced CT on POD3 revealed bilateral pulmonary embolism. On POD6, she developed sore throat and fever and was diagnosed with COVID-19. Anticoagulation stabilized her condition, and she was discharged on POD27.

This case underscores three lessons: (1) avoid anchoring on the first diagnosis because pneumothorax and pulmonary embolism share symptoms; persistent hypoxemia after drainage warrants early Contrast-enhanced CT; (2) when high-risk complications coexist, management must explicitly address bidirectional treatment interactions; and (3) minimizing operative time is a key preventive measure, and in elderly patients with large glenoid defects and cuff deficiency, primary reverse shoulder arthroplasty may be a reasonable alternative to complex arthroscopic reconstruction.