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Review
. 2022 Mar;36(3):e24256.
doi: 10.1002/jcla.24256. Epub 2022 Jan 28.

Pulmonary embolism following the third thoracic tuberculosis surgery: A case report and literature review

Liyi Chen  1 , Chong Liu  1 , Tuo Liang  1 , Zhen Ye  1 , Shengsheng Huang  1 , Xuhua Sun  1 , Ming Yi  1 , Tianyou Chen  1 , Hao Li  1 , Wuhua Chen  1 , Jie Jiang  1 , Jiarui Chen  1 , Hao Guo  1 , Yuanlin Yao  1 , Shian Liao  1 , Chaojie Yu  1 , Binguang Fan  1 , Shaofeng Wu  1 , Xinli Zhan  1
Affiliations
Review

Pulmonary embolism following the third thoracic tuberculosis surgery: A case report and literature review

Liyi Chen et al. J Clin Lab Anal. 2022 Mar.

Abstract

Background: The study aimed to analyze the clinical effects of pulmonary embolism succeeding a third surgery conducted for multiple recurrences in thoracic tuberculosis (TB).

Case report: A 74-year-old female patient developed thoracic tuberculosis and was subsequently treated in our hospital in March 2019, October 2020, and February 2021. The third surgical intervention included anterolateral thoracic lesion resection, internal fixation, posterior spinal tuberculous sinus resection, and debridement with suture. The operative time was 172 min resulting in a substantial intraoperative blood loss (2321 ml). Postoperative re-examination of chest CTPA indicated a strip filling defect and pulmonary embolism in the external branch of the right middle lobe of the lung. After completing the active treatment, the D-dimer quantification, WBC, CRP, and ESR values were 1261 ng/ml, 7.71 × 109 /L, 74.66 mg/L, and 63 mm, respectively. Chest CTPA re-examination after the treatment showed no signs of pulmonary embolism.

Conclusion: Patients with a long-term history of multiple operations, high BMI, cerebral infarction, diabetes, and older age group were more likely to develop pulmonary embolism after spinal tuberculosis surgery. Thus, the possibility of postoperative pulmonary embolism should be thoroughly analyzed before any subsequent surgical treatment in patients with recurrent spinal tuberculosis.

Keywords: pulmonary embolism; recurrence; surgery; thoracic tuberculosis.

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Conflict of interest statement

All authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Preoperative and postoperative X‐ray examinations during the first surgery in March 2019. (A) The arrow points to the preoperative T7 focal vertebral body in the coronal plane. (B) The arrow points to the preoperative T7 focal vertebral body in the sagittal plane. (C) The arrow points to the postoperative T7 focal vertebral body in the coronal plane. (D) The arrow points to the postoperative T7 focal vertebral body in the sagittal plane
FIGURE 2
FIGURE 2
Patient re‐examined by CT after the first surgery 18 months postoperatively. (A) This is a picture of bilateral pedicle screw placement in T10. (B) This is a picture of bilateral pedicle screw placement in T6. (C) This is a CT 3D reconstruction of the coronal plane. (D) This is a CT 3D reconstruction of the sagittal plane
FIGURE 3
FIGURE 3
Preoperative and postoperative X‐ray examinations during the second surgery in October 2020. (A) The arrow points to the preoperative T6 focal vertebral body in the coronal plane. (B) The arrow points to the preoperative T6 focal vertebral body in the sagittal plane. (C) The arrow points to the postoperative T6 focal vertebral body in the coronal plane. (D) The arrow points to the postoperative T6 focal vertebral body in the sagittal plane
FIGURE 4
FIGURE 4
Preoperative CT examination performed during the second surgery. (A) The arrow points to the T5 paraspinal abscess. (B) The arrow points to the T6 paraspinal abscess. (C) The arrow points to the bone destruction in the T5 vertebral body. (D) The arrow points to the bone destruction in the T6 vertebral body
FIGURE 5
FIGURE 5
Preoperative MRI examination performed during the second surgery. (A) The arrow points to the T5/6 paraspinal abscess in the T2 sequence. (B) The arrow points to the T5/6 paraspinal abscess in the T2 lipid pressing sequence. (C) The arrow points to the T5/6 intervertebral space lesions in the T2 sequence. (D) The arrow points to the T5/6 intervertebral space lesions in the T2 lipid pressing sequence. (E and F) The arrow points to the T5/6 paraspinal abscess in the T2 sequence cross section
FIGURE 6
FIGURE 6
Preoperative and postoperative X‐ray examinations conducted during the third surgery in February 2021. (A) The arrow points to the preoperative T6 focal vertebral body in the coronal plane. (B) The arrow points to the preoperative T6 focal vertebral body in the sagittal plane. (C) The arrow points to the postoperative T6 focal vertebral body in the coronal plane. (D) The arrow points to the postoperative T6 focal vertebral body in the sagittal plane
FIGURE 7
FIGURE 7
Preoperative CT examination performed during the third surgery. (A) The arrow points to the T5 paraspinal abscess. (B) The arrow points to the T5/6 paraspinal abscess. (C) The arrow points to the T6 paraspinal abscess. (D and E) The arrow points to the bone destruction in the T6 vertebral body
FIGURE 8
FIGURE 8
Preoperative MRI examination performed during the third surgery. (A) The arrow points to the T5/6 paraspinal abscess in the T1 sequence. (B) The arrow points to the T5/6 intervertebral space lesions in the T1 sequence. (C) The arrow points to the T5/6 paraspinal abscess in the T2 sequence. (D) The arrow points to the T5/6 intervertebral space lesions in the T2 sequence. (E) The arrow points to the T5/6 paraspinal abscess in the T2 lipid pressing sequence. (F) The arrow points to the T5/6 intervertebral space lesions in the T2 lipid pressing sequence. (G) The arrow points to the T5/6 paraspinal abscess in the T2 sequence cross section
FIGURE 9
FIGURE 9
Preoperative and postoperative blood tests performed during the hospital stay. (A) The WBC value. (B) The HGB value. (C) The PLT value. (D) The neutrophil percentage value
FIGURE 10
FIGURE 10
Preoperative and postoperative blood tests performed during the hospital stay. (A) The CRP value. (B) The ESR value. (C) The D‐dimer quantification value
FIGURE 11
FIGURE 11
Daily monitoring of the patient's vital signs in the hospital. (A) The temperature examination value. (B) The pulse examination value. (C) The respiration examination value. (D) The blood pressure examination value
FIGURE 12
FIGURE 12
Postoperative CT examination performed during the third surgery. (A and B) The nail bar system is fixed well in the sagittal plane. (C and D), The titanium cage and the plate system are aligned correctly in the sagittal plane. (E and F) The titanium cage and the plate system are fixed well in the coronal plane. (G and H) The titanium cage and the plate system are aligned correctly in the cross‐sectional area
FIGURE 13
FIGURE 13
Body mass index measured thrice in all the hospital visits
FIGURE 14
FIGURE 14
Preoperative chest CTPA examination performed during the third surgical intervention. (A and B) The arrow points to the pulmonary embolism in the external branch of the right middle hepatic lobe. (C and D) The arrow points to the normal pulmonary architecture in the external branch of the right middle hepatic lobe, showing no signs of pulmonary embolism after the treatment
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