engleski

POSTOPERATIVE ACUTE DYSPNEA AFTER KNEE JOINT TOTAL ENDOPROSTHESIS - NOT ALWAYS A HEART PROBLEM OR PULMONARY EMBOLISM

Learning objectives Sudden acute dyspnea during rehabilitation after knee surgery is a potentially life- threatening complication. Although acute life- threatening postoperative dyspnea in most cases indicates a heart or pulmonary problem, a thyroid dysfunction with a large goiter (even if rare) must be taken into account in the differential diagnosis. Case A 78-year-old man with a history of arterial hypertension, diabetes and obesity was admitted to the rehabilitation department five days after knee total joint endoprosthesis. The usual thrombosis prophylaxis with rivaroxaban was carried out. Two days later, the patient complained of acute dyspnea. The physical examination showed the following results: The blood pressure was 132/87 mmHg with a regular pulse (88 / min). The respiratory rate was 24 breaths / min with normal oxygen saturation (97%) under ambient air. Body temperature was 36.7 ° C. Routine blood tests, including troponin and arterial blood gas analysis, showed normal values. The D-dimer was slightly increased. The electrocardiogram (ECG) showed no abnormalities. Transthoracic echocardiography revealed mild pulmonary hypertension. The conventional chest x-ray showed signs of pulmonary emphysema. Computed tomography was performed to rule out pulmonary embolism. In addition, there was a massive newly diagnosed thyroid goiter with severe tracheal stenosis. Sonographically enlarged thyroid gland with several nodules. The local physical condition was unremarkable. The laboratory tests showed a Thyroid-stimulating hormone (TSH) content of <0.002 mU / L, Free Triiodothyonine (fT3) of 22.5 pmol / L, Free thyroxine (fT4) of 4.6 pmol / L and thyroglobulin levels of 141 µg / L. Because of the severe tracheal stenosis, the patient was transferred to the surgical department for further treatment. Discussion The thyroid hormones have various effects on the heart, blood vessels and the respiratory system. Pulmonary hypertension, which is likely caused by increased pulmonary vascular resistance (according to the hemodynamic hypothesis), is one of the known consequences, although the actual pathophysiological mechanisms between hyperthyroidism and pulmonary hypertension remain unclear. Because of this, mildly progressive dyspnea often occurs during daily activities in patients with thyroid dysfunction, especially hyperthyroidism. Rarely, a significantly enlarged thyroid gland, as in our case, can cause life-threatening airway obstruction. In such cases, timely diagnosis and early surgery should be done to prevent respiratory failure and potential fatal complications.

dyspnea, knee joint, total endoprosthesis

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