title: Silent pulmonary thromboembolism in neurosurgery patients: Report of 2 cases and literature review.
abstract: BACKGROUND
  The requirement of postoperative bedridden and immobilization renders neurosurgical patients with higher risk of deep vein thrombosis (DVT), then more vulnerable for pulmonary thromboembolism (PTE). But silent pulmonary thromboembolism (SPTE) can be the very early stage of any typical form of PTE, its diagnosis and management is therefore critical in neurosurgical departments. However, to date, perioperative SPTE has not been attached with enough attention.
  
  
  METHODS
  Here, we report 2 cases of perioperative SPTE in the Department of Neurosurgery, Peking Union Medical College Hospital, Beijing, China. Clinical data of 2 cases was collected and analyzed. Both patients were screened by quantitative D-dimer assay and lower limbs ultrasonography, while diagnoses were made according to computed tomographic pulmonary angiography (CTPA). Therapeutic medications include heparin, low molecular weight heparin, followed by long-term anticoagulation with oral warfarin. Both cases showed significantly elevated D-dimer before and after onset of SPTE. But in 1 case, ultrasonography reported negative venous thromboembolism. CTPA confirmed all diagnosis of SPTE. Repeated CTPA after anticoagulant therapy identified therapeutic efficacy. And during the follow-up period of 5 or 6 years, both patients acquired full recovery without clinical complications.
  
  
  RESULTS
  Significant decline of D-dimer was observed after the comprehensive management of SPTE (case 1: preop vs postop 573 vs 50 μg/L; case 2: preop vs postop 246 vs 50 μg/L). Ultrasonography was used for suspicious of DVT, while CTPA was used for confirming SPTE diagnosis.
  
  
  CONCLUSIONS
  Clinicians should be aware of the importance of early recognition of SPTE. Effective management of risk factors of hyper-coagulation state should be the key to prophylaxis. And routine monitor of D-dimer as well as regular check of lower limbs ultrasonography should be standardized and included in guidelines of neurosurgical patient management.
authors.affiliation: Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Tian
authors.forename: Jun
authors.initials: J
authors.lastname: Gao
authors.forename: Alof
authors.initials: A
authors.lastname: Chen
authors.forename: Xinjie
authors.initials: X
authors.lastname: Bao
authors.forename: Jian
authors.initials: J
authors.lastname: Guan
authors.forename: Ming
authors.initials: M
authors.lastname: Feng
authors.forename: Yongning
authors.initials: Y
authors.lastname: Li
authors.forename: Wenbin
authors.initials: W
authors.lastname: Ma
authors.forename: Zuyuan
authors.initials: Z
authors.lastname: Ren
authors.forename: Renzhi
authors.initials: R
authors.lastname: Wang
authors.forename: Junji
authors.initials: J
authors.lastname: Wei
mesh_terms: D000368:Aged; D000072226:Computed Tomography Angiography; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000601:surgery; D008579:Meningioma / Q000601:surgery; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology*