Poster - #2022SPHU-22 - Keywords: Basilic Vein Thrombosis Intravenous Line Infiltration:Pulmonary Embolism

Basilic Vein Thrombosis Secondary to Intravenous Line Infiltration: A Potential Provoking Factor for Pulmonary Embolism

Shikha Jha MD
Saint Peter’s University Hospital, New Jersey, USA

ABSTRACT:
Background: Pulmonary embolism due to superficial vein thrombosis of the basilic vein is a very rare clinical manifestation. Due to the higher incidence of being undiagnosed, the true incidence of superficial vein thrombosis complicated by pulmonary embolism remains underestimated. Case presentation: A 26-year-old gentleman, presented to the emergency department with a chief complaint of sharp right-sided substernal chest pain, associated with shortness of breath for 5 days. His last visit to the emergency department was 10 days back for abdominal pain secondary to an umbilical hernia. He was given intravenous ketorolac and discharged the same day with instructions for outpatient surgery follow-up. He reported infiltration of the right arm intravenous line at that time. He had been experiencing significant right arm pain and swelling since the intravenous line insertion and removal. Vitals were pertinent for a heart rate of 106 beats/minute. Physical exam was significant for tenderness and swelling in his right arm with localized redness at the previous intravenous line site. Results: The electrocardiogram showed normal sinus rhythm with a ventricular rate of 92 beats per minute. The The duplex scan of his right upper extremity showed an acute nonocclusive superficial vein thrombosis with a floating tail involving the right basilic vein. The duplex scan of the rest of all extremities was negative. The CT Pulmonary Angiogram showed right lower lobe pulmonary embolism with evolving infarct. Decision making: The patient was started on an intravenous heparin drip upon admission. His symptoms resolved in the next 24 hours. He was later transitioned to directly acting oral anticoagulation, rivaroxaban, for a total of 3 months duration. He was instructed to watch for bleeding risks and obtain outpatient hypercoagulability work up to rule out other possible etiology. Conclusion: Intravenous line infiltration requires prompt medical attention, as it can be complicated by thrombus formation. Superficial vein thrombosis of the upper extremity is increasingly being recognized as a potential source of pulmonary embolism. The involvement of the basilic vein often presents with localized redness, pain, and swelling of the involved arm. The subsequent onset of chest pain with shortness of breath should raise a strong suspicion of pulmonary embolism.