Pulmonary embolism presenting as abdominal pain: an atypical complication after rhinoplasty

Abstract

Embolism of the pulmonary artery or one of its branches is the most striking and characteristic appearance of thromboembolic disease. Surgery is defined as a major transient risk factor of VTE, and almost 25% of all cases can be attributed to a recent surgery. The risk of postoperative PE is highest during the first 5 weeks after surgery and is related to the type of surgery. Here we report the case of a 44-year-old man who presented with right upper quadrant abdominal pain that has been going on for several hours with axillary temperature up to 38 °C. The pain intensifies when inhaling. There were no other symptoms. Due to the information about the recent operations and the change on the tangential scan of the right lung, the patient underwent a coagulogram, which revealed elevated D dimer and fibrinogen. The patient referrers to a pulmonologist who suggests a CT angiography which revealed in one segmental branch, and its two associated subsegmental branches a. pulmonalis dextral for the posterobasal segment of the lower lobe of the lung parenchyma on the right, visible minor hypodense changes corresponding to smaller thrombotic masses. The patient was admitted to the Clinic of pulmonology JZU UKC Tuzla where he was prescribed low molecular weight heparin and antibiotic therapy. After discharge, the patient continued to take warfarin orally for anticoagulant treatment. Given that the patient could not achieve the target INR values (INR 2-3), the therapy was changed to new anticoagulant drugs (NOAC-Apixaban).