title: Varicose vein trauma: a risk for pulmonary embolism.
abstract: Pulmonary embolism (PE) is a deceptive condition which is often incorrectly diagnosed leading to high morbidity and mortality. We present a case where symptoms were localised to different areas of the body starting with post-traumatic pain over lower extremity varicosities that migrated sequentially over a month to the knee, hip, back, abdomen and chest finally presenting as syncope. Despite a low pre-test clinical probability, a very high index of suspicion led to a timely diagnosis of a massive bilateral PE that eventually caused a troponin leak. The aetiology is highly suspicious of a thrombus which originated in the veins of the leg due to trauma over varicose veins.The case described here exemplifies the importance of considering trauma to varicosities as a risk factor for embolism when the clinical picture is concerning but other signs and symptoms of PE are not apparent.
authors.affiliation: Associate Phycisian, Department of Internal Medicine, University of Iowa Hospitals and Clinics, University of Iowa , Iowa, IA- 52242, USA .
authors.forename: Parijat S
authors.initials: PS
authors.lastname: Joy
authors.affiliation: Fellow Physician, Pulmonary and Critical care, Department of Medicine, Tahlequah City Hospital , Tahlequah, OK- 74464, USA .
authors.forename: Creticus P
authors.initials: CP
authors.lastname: Marak
authors.affiliation: Fellow Physician, Pulmonary and Critical care, Department of Medicine, Montefiore Hospital, Albert Einstein College of Medicine, Yeshiva University , New York, USA .
authors.forename: Anna M
authors.initials: AM
authors.lastname: Ponea
authors.affiliation: Instructor, Department of Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Harvard University , Boston, MA 02114, USA .
authors.forename: Achuta K
authors.initials: AK
authors.lastname: Guddati
keywords: Deep vein thrombosis; Troponin elevation