Acute pulmonary embolism originating from upper limb venous thrombosis following breast cancer surgery: Two case reports.

ABSTRACT

BACKGROUND: Upper limb venous thrombosis (ULVT) is rarer than lower-extremity deep venous thrombosis, and is related to Paget-Schroetter syndrome, central venous catheterization, and malignancy. There are few reports of pulmonary embolism (PE) from upper-extremity vein thrombosis due to surgery. Herein, we report two cases of PE that originated from upper limb venous thrombosis on the surgical side in two patients undergoing modified radical mastectomy for breast cancer. These cases challenge the traditional theory that PE originate only from the lower extremities. CASE SUMMARY: We describe two female patients, aged 68 and 65 years, respectively, who had undergone modified radical mastectomy for breast cancer. They did not have a central venous catheter and did not undergo preoperative neoadjuvant chemotherapy. They were transferred to the intensive care unit due to symptomatic PE on the first day after surgery. Colour Doppler ultrasound identified fresh thrombosis in their upper limb veins, which was the presumed source of the PE. They all received anticoagulation therapy, and one of them experienced bleeding that required discontinuation of the drug. Ultimately, they were discharged in stable condition. CONCLUSION: ULVT as a source of PE after breast cancer surgery cannot be ignored.