Recurrent, massive pulmonary embolism in chronic myelopathy: a case report.

Study Design: Case report.
Objectives: The aim of this report was to describe an example of pulmonary embolism (PE), recently suggested to be highly prevalent in persons with chronic spinal cord lesions.
Setting: Veterans Affairs Hospital, Boston, MA, USA.
Methods: Chart review.
Results: A 60-year-old man with paraplegia, T10 motor complete, underwent laminectomy for correction of an arteriovenous malformation. After 41 days, he sustained a massive PE-suggested by right bundle branch block (RBBB) on an electrocardiogram (ECG) and diagnosed by perfusion lung scanning. He was treated with anticoagulants, the lung scan and RBBB resolving within 1 month of initiating treatment. After 5 years, he developed vertebral osteomyelitis at L5-S1 and was treated with antibiotics and bed rest. After 7 days, he was mobilized to a wheelchair, and during a transfer back to bed, he developed anxiety, dyspnea, fluctuating consciousness, low blood pressure and RBBB, absent by ECG 4 days earlier. He expired 20 min after onset of symptoms. The autopsy revealed a fresh thromboembolus occluding both main stem branches of the pulmonary artery.
Conclusion: Massive PE after surgery in a patient with chronic paraplegia recurred 5 years later in association with severe infection and mobilization after bed rest, which resulted in death.