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VOLUME 21 , ISSUE 6 ( 2017 ) > List of Articles


Metatarsal fracture leading to massive pulmonary embolism

Vikas Rajpurohit, Prateek Tejvir, Neelam Meena, Kailash Mittal

Keywords : Fracture, metatarsal fracture, pulmonary embolism, thrombolysis

Citation Information : Rajpurohit V, Tejvir P, Meena N, Mittal K. Metatarsal fracture leading to massive pulmonary embolism. Indian J Crit Care Med 2017; 21 (6):401-403.

DOI: 10.4103/ijccm.IJCCM_125_17

License: CC BY-ND 3.0

Published Online: 01-06-2018

Copyright Statement:  Copyright © 2017; The Author(s).


Immobilization and bed rest after fracture and orthopedic surgery are routinely advised protocol. Period of bed rest usually depends on the type of injury and orthopedic procedure, ranging from few days to weeks. The trauma, surgery, and immobilization with other contributing factors can lead to deep vein thrombosis and pulmonary embolism (PE) in these patients. Although there is high incidence of PE in such patients, it is difficult to diagnose, primarily because of the variety of nonspecific signs and symptoms. Here, we discuss a case of a 30-year-old female, who had suffered a trivial roadside accident leading to metatarsal bone fracture and later on presented in emergency with seizures, pulmonary edema, and cardiac arrest, after immobilization of just 5 days which was diagnosed to be result of massive PE. Here, we will discuss the pathophysiology, risk factors, and management of massive PE.

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  1. Soohoo NF, Farng E, Zingmond DS. Incidence of pulmonary embolism following surgical treatment of metatarsal fractures. Foot Ankle Int 2010;31:600-3.
  2. Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ, et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: A scientific statement from the American Heart Association. Circulation 2011;123:1788-830.
  3. Mitchell RN, Kumar V. Hemodynamic disorders, thrombosis, and shock. Robbins SL, editor. Basic Pathology. 6th ed. Philadelphia: WB Saunders; 1997. p. 60-80.
  4. Davies GS, Salzman EW. The pathogenesis of deep vein thrombosis. In: Joist HJ, Sherman LA, editors. Venous and Arterial Thrombosis: Pathogenesis, Diagnosis, Prevention, and Therapy. New York: Grune & Stratton; 1979. p. 1-22.
  5. Velmahos GC, Spaniolas K, Tabbara M, Abujudeh HH, de Moya M, Gervasini A, et al. Pulmonary embolism and deep venous thrombosis in trauma: Are they related? Arch Surg 2009;144:928-32.
  6. Hatch RL, Alsobrook JA, Clugston JR. Diagnosis and management of metatarsal fractures. Am Fam Physician 2007;76:817-26.
  7. Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S, et al. Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141 2 Suppl: e278S-325S.
  8. Clinical Guideline: Venous Thromboembolism: Reducing the Risk for Patients in Hospital; 2010. Available from: [Last cited on 2017 May 01].
  9. Cohen AT, Tapson VF, Bergmann JF, Goldhaber SZ, Kakkar AK, Deslandes B, et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): A multinational cross-sectional study. Lancet 2008;371:387-94.
  10. Kline JA, Runyon MS. Pulmonary embolism and deep venous thrombosis. In: Marx JA, Hockberger RS, Walls RM, editors. Rosen's Emergency Medicine Concepts and Clinical Practice. 6th ed. Philadelphia: Saunders 2005. p. 1368-82.
  11. Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N, et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 2014;35:3033-69.
  12. Stein PD, Beemath A, Matta F, Weg JG, Yusen RD, Hales CA, et al. Clinical characteristics of patients with acute pulmonary embolism: Data from PIOPED II. Am J Med 2007;120:871-9.
  13. Stein PD, Woodard PK, Weg JG, Wakefield TW, Tapson VF, Sostman HD, et al. Diagnostic pathways in acute pulmonary embolism: Recommendations of the PIOPED II Investigators. Radiology 2007;242:15-21.
  14. Konstantinides S. Clinical practice. Acute pulmonary embolism. N Engl J Med 2008;359:2804-13.
  15. Dresden S, Mitchell P, Rahimi L, Leo M, Rubin-Smith J, Bibi S, et al. Right ventricular dilatation on bedside echocardiography performed by emergency physicians aids in the diagnosis of pulmonary embolism. Ann Emerg Med 2014;63:16-24.
  16. Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuünemann HJ; American College of Chest Physicians Antithrombotic Therapy and Prevention of Thrombosis Panel. Executive summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141 2 Suppl:7S-47S.
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