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July 1992

Patient-Induced Pulmonary Embolism

Author Affiliations

Washington, DC

Arch Intern Med. 1992;152(7):1532. doi:10.1001/archinte.1992.00400190148035

To the Editor. —  The subject of pulmonary emboli complicating upper extremity deep venous thrombosis was recently discussed in the Archives.1 While such events are uncommon, the occurrence of pulmonary embolism originating in upper extremity superficial veins is even rarer.2 The following is a case of presumed pulmonary emboli, unwittingly induced by the patient's manipulation of a thrombosed, superficial, upper extremity vein.

Report of a Case. —  A 76-year-old woman with breast cancer diffusely metastatic to her skeleton, bone marrow, pulmonary interstitium, and subcutaneous tissues was admitted for packed red blood cell transfusions to palliate symptomatic lightheadedness associated with a hematocrit index of 0.26. A 20-gauge plastic catheter was placed without difficulty in the cephalic vein approximately 5 cm above the wrist. During the next 12 hours, she received 2 units of packed red blood cells, 20 mg of furosemide, and heparin flushed through intravenously. Catheter removal was