A case report of asymptomatic pulmonary thromboembolism and deep vein thrombosis without any subjective symptoms identified by an abnormal D-dimer value during a preoperative screening test

Pulmonary thromboembolism (PTE) can be a fatal complication during the perioperative period. PTE is caused by acute pulmonary thromboembolism that leads to subjective symptoms such as shock and hypotension, but asymptomatic PTE without any subjective symptoms is also noted in some cases. Therefore, PTE is difficult to accurately diagnose in patients without any clinical signs or specific subjective symptoms. We encountered a case of asymptomatic PTE and deep vein thrombosis (DVT) that was identified because of an abnormal D-dimer value during a preoperative screening test The patient was an 86-year-old woman who had been scheduled to undergo a partial resection of the maxilla for the resection of maxillary gingival cancer. The patient did not exhibit any subjective symptoms suggesting PTE or DVT, but a preoperative examination revealed an elevated D-dimer level of 10.3 μg/ml. So, we performed a contrast-enhanced CT examination and found numerous thrombi in bilateral pulmonary arteries of the inferior lobe and at the bilateral calf level. Anticoagulation therapy was immediately initiated. After the disappearance of the thrombi based on a contrast-enhanced CT re-examination performed 10 days later, the planned surgery was performed. The recurrence of PTE/DVT was not observed during the perioperative period. The guidelines for the diagnosis, treatment, and prevention of pulmonary thromboembolism and deep vein thrombosis in Japan (JCS 2009) do not include any mention of preoperative examinations. Therefore, such examinations are performed based on the protocol of each hospital. Our case suggests that a D-dimer test is useful as a screening test for PTE/DVT in elderly cancer-bearing patients.