Massaging the outcome: an unusual presentation of pulmonary embolism

Abstract

A 56-year-old man with a previous deep venous thrombus presented with dyspnoea after a leg massage. A transthoracic echocardiogram demonstrated a "worm-shaped" right atrial embolus, most probably a femoral cast. A pulmonary artery angiogram confirmed a large wedge-shaped perfusion defect caused by a pulmonary embolus. There are previous case reports about leg massage causing pulmonary emboli but this is the first reported event where the thrombus has been visualised directly. Also, it demonstrates the important role that echocardiography plays in pulmonary embolus.

Leg massage during pregnancy with unrecognized deep vein thrombosis could be life threatening: a case report

“…The onset of cardiovascular collapse was shortly after leg massage, highly suggestive of thrombus embolization. Unlike most previous case reports of leg massage, concerning induced pulmonary embolism that occurred in previously known cases of deep vein thrombosis in non-pregnant patients [2][3][4], the case presented here is the first case report of leg massage leading to thrombi dislodge with the consequence of severe morbidity in a healthy pregnant woman who had undetected preexisting deep vein thrombosis, which was likely aggravated by physiologic changes during pregnancy. Unfortunately, our patient had not attended antenatal clinic before the event.…”

“…Furthermore, echocardiography is also useful in risk categorization and prognosis in pulmonary embolism. The echocardiographic features suggesting pulmonary embolism are poor contractility of the right ventricle, right ventricular dilatation, tricuspid regurgitation, paradoxical motion of the interventricular septum, pulmonary artery dilatation, elevated pulmonary pressures, empty left heart and, rarely, a right heart thrombus [4].…”

“…Though systematic reviews on the effectiveness of massage therapy have demonstrated positive conclusions, adequate risk-benefit evaluations are not feasible, and several case reports indicate that it is not entirely risk free, though serious adverse events are probably rare [1]. Pulmonary embolism is the most serious consequence of massage, which has rarely been reported [2][3][4]. To the best of our knowledge, this is the first case of traditional massage causing massive pulmonary embolism in a healthy pregnant woman.…”

Development of paradoxical cerebral embolism during lymphatic draining massage: A case report

“…It is considered safe; however, a few cases of pulmonary embolism have been reported that developed in association with massage. 7,8 The moving of thrombi centrally from the periphery by massage is considered to contribute to embolism. As far as we know, the present case is the first to report PCE in association with lymphatic draining massage.…”

Leg massage by mother resulting in fatal pulmonary thromboembolism

“…Warren 9 reported a case in which, a 72-year-old woman developed a pulmonary embolus after her husband had performed vigorous massage of her leg, which was already affected by deep vein thrombophlebitis. Lim et al 10 reported a case in which a 56-year-old man with diagnosed deep venous thrombus two years ago presented with dyspnoea after a leg massage. A pulmonary artery angiogram revealed a large wedge-shaped perfusion defect caused by a pulmonary embolus.…”