A Case of DVT with PE

Posted on Aug 18, 2014

American idol finalist Michael Johns was found dead at his home a few weeks ago secondary to complications associated with a deep venous thrombosis (DVT) or blood clot. Johns was an avid tennis player and sustained an ankle injury a few weeks ago. He then developed increasing swelling, redness and pain in his injured leg. Tragically, the following evening Michael was found dead by one of his friends due to a pulmonary embolism (PE) or a blood clot in the lungs.

A DVT or blood clot is a rare complication following a traumatic musculoskeletal injury or orthopedic surgical intervention. The risk of developing a deep venous thrombosis is increased with medical conditions including venous stasis, endothelial damage and a hypercoagulable state. Let’s learn what these are. Venous stasis includes prolonged immobility such as long plane or car trips, being bed bound during hospitalizations and casting or splinting. Medical conditions such as high blood pressure, high cholesterol, and bacteria in the blood stream and the use of PICC lines or central venous catheters can cause endothelial damage (damage to the lining of vessel walls). Smoking, birth control, cancer, obesity, pregnancy and hyperviscosity syndromes (i.e. Protein S, Protein C and Factor V Leiden Deficiencies) can cause blood hypercoagulability (increased ability of the blood to form clots).

If you have been evaluated for a traumatic musculoskeletal injury or recently had surgery, you likely have been given some information on the prevention of blood clots. Prevention is aimed at reducing the risk factors listed above. Mobility or mobility devices like ankle pumps may be used to decrease the risk of DVT. Controlling risk factors by not smoking, avoid birth control and losing weight may be encouraged. The use of anticoagulation medications (injections or pills) after surgery for DVT prevention may also be prescribed to you.

Symptoms of a deep venous thrombosis include increased pain, swelling and redness about an extremity. A blood clot in the extremities can dislodge from the lining of the vein and travel through the venous system and into the pulmonary arteries. This embolism (traveling blood clot) clot can become lodged within the pulmonary arteries at different sites causing a difficult exchange of oxygen from the lungs into the bloodstream. This can completely impede the exchange of oxygen and can be terminal. Symptoms of a pulmonary embolism include shortness of breath, increased heart rate and increased respiratory rate.

The clinical examination of a deep venous thrombosis is often unreliable. If there is suspicion of a blood clot in a post-surgical patient or a patient with a recent musculoskeletal trauma, further testing should be done to rule out a DVT. A doppler venous ultrasound of the affected lower extremity is obtained to rule out a blood clot. If a pulmonary embolism is suspected, a computer tomography (CT) scan of the chest is often obtained.

A DVT is a serious medical condition. It is important to seek medical attention if you recently had surgery or a traumatic injury and are having symptoms associated with a deep venous thrombosis or pulmonary embolism. Prompt diagnosis and medical intervention may prevent a catastrophic event like that suffered by the American Idol star Michael Johns.

“Former ‘American Idol’ finalist Michael Johns dies at 35″ from the Washington Post

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