Intraventricular Thrombosis and Pulmonary Embolism Post-Nuss Procedure: A Rare Case of Chronic Bar Displacement in a 16-Year-Old Patient

Chest. 2024 Jun;165(6):e163-e167. doi: 10.1016/j.chest.2024.01.035.

Abstract

This novel report presents the first known case, to our knowledge, of a 16-year-old male patient who experienced intraventricular thrombosis and pulmonary embolism after a Nuss procedure for pectus excavatum, attributed to chronic bar displacement. Two years after the operation, the patient experienced post-exercise cough and hemoptysis, which led to his admission. Imaging revealed pulmonary embolism, thrombosis in the right ventricular outflow tract, and lung infiltrative lesions. We hypothesize that the chronic bar displacement led to its embedment in the right ventricle, resulting in thrombus formation, which subsequently contributed to partial pulmonary embolism. Surgery revealed the bars' intrusion into the right ventricle and lung. This case highlights the risk of severe complications from bar displacement in the Nuss procedure, which necessitates long-term follow-up evaluation, caution against strenuous activities after surgery, and use of thoracoscopic guidance during bar implantation and removal. It underscores the importance of vigilant evaluation for late-stage complications in patients with respiratory distress or thrombosis after a Nuss procedure.

Keywords: Nuss procedure; bar displacement; intraventricular thrombosis; pectus excavatum; pulmonary embolism.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Funnel Chest* / surgery
  • Heart Ventricles / diagnostic imaging
  • Humans
  • Male
  • Postoperative Complications / diagnosis
  • Postoperative Complications / etiology
  • Pulmonary Embolism* / diagnosis
  • Pulmonary Embolism* / etiology
  • Thrombosis* / diagnosis
  • Thrombosis* / diagnostic imaging
  • Thrombosis* / etiology
  • Tomography, X-Ray Computed