Massive Pulmonary Embolism Occurred Pre-Oreratively In A Patient With Anterior Cruciate Ligament Rupture: Should We Consider Initiating Thromboprophylaxis Before Surgery?

Purpose: To present a case of massive pulmonary embolism occurred pre-operatively in a patient with ACL rupture. Case: A 26-year-old male patient was referred to our clinic with a history of direct trauma to his right knee occurred during a soccer match 3 weeks previously. The American Society of Anesthesiologists (ASA) score was 1. He did not smoke. He had not been using any specific drug treatment for systemic medical conditions. He had no past medical history of surgery or hospitalization. The night before scheduled surgery, he suffered from an acute onset of serious shortness of breath and sharp pain on both sides of his chest. Computed tomography (CT) pulmonary angiogram was performed. Massive PE of the bilateral main pulmonary arteries was diagnosed. The patient survived and arthroscopic ACL reconstruction was postponed. Conclusion: Life-threatening pulmonary embolism may occur pre-operatively even in a young patient with isolated ACL rupture and without any risk factors thus; ideal timing of thromboprophylaxis should be questioned