There was some mild tenderness and ecchymoses at the operative site but no edema or swelling. In light of his recent procedure and his symptoms, lower extremity Doppler ultrasound studies were ordered and performed 36 hours after his visit to the PCP. physicians should be aware of this if a patient presents with symptoms suggestive of an embolic event. == Case presentation == A 35-year-old Asian man without a significant medical history presented to our health center for elective outpatient vasectomy. The procedure was performed bilaterally using the no-scalpel approach in an office setting over 30 minutes without any apparent incident or complication and he was discharged. He returned home and reported that he slept for about two hours in bed. Upon arising, he noticed that he Mutant IDH1 inhibitor felt somewhat short of breath and experienced dyspnea on exertion as well as vague substernal chest pain; none of his symptoms were sufficiently severe to lead him to seek immediate medical attention. He subsequently presented to his primary care physician (PCP) four days following the vasectomy procedure because of continued feelings of shortness of breath and chest pain. The rest of the history was unremarkable, as was his physical examination and electrocardiogram. He had no swelling, tenderness, warmth or redness of his legs. There was Mutant IDH1 inhibitor some mild tenderness and ecchymoses at the operative site but no edema or swelling. In light of his recent procedure and his symptoms, lower extremity Doppler ultrasound studies were ordered and performed 36 hours after his visit to the PCP. The Doppler studies demonstrated venous thrombosis in the Mutant IDH1 inhibitor right popliteal vein. A computed tomogram (CT) angiogram was immediately arranged which re-demonstrated a clot in the right popliteal vein (Figure1). Additionally, it also demonstrated large, multiple, bilateral pulmonary emboli (Figures2and3). == Figure 1. == == Figure 2. == == Figure 3. == He did not have any prior history of deep venous thrombosis (DVT) and was not aware of any family history of the disorder. He was taking no medications at the time Mutant IDH1 inhibitor of the vasectomy. He was a non-smoker. An extensive laboratory work-up was performed in search of any underlying disorders predisposing to thromboembolism (Table1). All studies returned within the normal limits. D-Dimer and Factor VIII levels were not checked, as these tests were not routinely utilized as part of a thromboembolic workup at the time of the event. == Table 1. == Selected test values for patient. The patient was treated initially for his pulmonary embolism as an outpatient with enoxaparin and then switched to warfarin for six months. The patient tolerated this therapy well and did not develop any bleeding complications or symptoms suggestive of recurrent embolism. A CT angiography of the chest, pelvis and legs was repeated 76 days after the initial study to confirm resolution of the thrombi. This demonstrated complete resolution of the pulmonary emboli, with no residual clot in the pulmonary or lower extremity venous systems. Symptomatically, he has also returned to baseline by this point. To date, he has not had any evidence of recurrent thrombosis or thromboembolism. == Discussion == We present here the case of a previously healthy man who developed extensive pulmonary emboli shortly after an elective vasectomy procedure. We believe there is a Rabbit polyclonal to LAMB2 direct relationship between the two events, most likely mediated by venous stasis and inflammation from procedural trauma. It is impossible to exclude a chance association in our case between the thromboembolic event and the vasectomy. However, our patient had no identifiable underlying hypercoaguable state and he has not had any recurrent thromboembolism in the eight years since his vasectomy. These factors strongly suggest that his.