Right Arm Swelling After Surgery

Consult Page

30F with recent spine surgery, here with right arm swelling

Initial Imaging

None

Walking Thoughts

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  What surgery did she have? How long ago was her surgery?

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  What was her postoperative course? When and where did she discharge?

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  What is her level of mobility?

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  What are the patient’s current vital signs? Is she hemodynamically stable?

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  What is the mechanism and timeline of her arm swelling? Did she have any trauma? Does she have any risk factors for hypercoagulability?

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  What studies need to be ordered (ultrasound, CT angiogram [CTA] of the chest)?

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  Does she need to be started urgently on anticoagulation? If so, what are the risks and benefits associated with that decision?

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  What is the most appropriate anticoagulation agent to use in the postoperative setting?

History of Present Illness

A 30 year old female with recent cervicothoracic spine surgery presents to the emergency department (ED) with one day of right arm swelling. She underwent surgery one week prior after presenting to our hospital with progressive bilateral leg weakness and urinary retention, and was found to have an expansile, intramedullary cervicothoracic lesion concerning for an ependymoma ( Figure 69.1 ). The patient underwent an uncomplicated C5-T4 laminoplasty for resection of the lesion with C4-T5 instrumentation and fusion. Postoperatively, she had bilateral weakness in her arms and legs (right worse than left, legs worse than arms) with the inability to walk unassisted. Her postoperative course was otherwise unremarkable, and she was discharged to inpatient rehabilitation on postoperative day 6. While in rehabilitation, she was noted to have right upper extremity swelling without irritation or pruritus. She denied swelling, pain, irritation, pruritus, or erythema in her other extremities. She also denied any shortness of breath or recent IV infiltration.