Trauma is an unusual, but well documented, cause of pulmonary embolism (PE).1As we know from Virchow’s triad, thrombosis requires the presence of certain elements, including alteration to the vein wall, which may occur due to endothelial damage; and blood stasis, which may be caused by extended periods of immobility. Both conditions are associated with physical trauma.
A patient with recent trauma suffered a unique PE that arose directly from a joint dislocation that compressed a vein, placing him in grave danger. We treated him by administering Acoustic Pulse Thrombolysis™ (APT) using the EkoSonic® Endovascular System (BTG Interventional Medicine).
On November 15, 2017, a 25-year-old man complaining of chest pain and with evidence of significant chest trauma presented to the emergency department at Ochsner Baton Rouge Medical Center in Louisiana. Earlier that day he had suffered an accident while riding an all-terrain vehicle. Chest x-rays showed no signs of fracture, but an abnormality of his left clavicle was observed.
Further investigation with computed tomography angiography (CTA) detected a sternoclavicular dislocation — the clavicular head was disarticulated and posteriorly displaced. The dislocation was significant enough to compress the brachiocephalic vein. In addition, a small hematoma was noted in the superior anterior mediastinum. There was no sign of active hemorrhage or arterial injury, but there was evidence of a vascular-type injury, which was assumed to be venous.