Keshin M. Purohit, MD
Resident Physician
University of California Irvine
Garden Grove, California, United States
Michelle Nguyen, BS
Medical Student
University of California, Irvine, School of Medicine
Yorba Linda, California, United States
Armand Ardestani, DO
Chronic Pain Medicine Fellow Physician
University of California, Irvine
Orange, California, United States
Jason Koh, DO
Assistant Clinical Professor
UC Irvine Physical Medicine and Rehabilitation
Long Beach, California, United States
A 35-year-old female presented with two months of nausea and vomiting. MRI revealed a right cerebellar mass and she underwent craniotomy and resection. A chest CT identified a left paramediastinal mass and a biopsy confirmed adenocarcinoma. Her hospital course was complicated by pulmonary embolism, requiring IVC filter placement. Doppler ultrasound of the upper and lower extremities was negative. She was transferred to an acute rehab unit (ARU) without anticoagulation, per hematology and oncology recommendations. On day 6 of rehabilitation she reported 7/10 left calf pain. Repeat ultrasound was negative for thrombosis. The next day, her left calf was firm and hyperesthetic. A CT scan demonstrated a chronic medial malleolus fracture and vague hypodensity in the soleus muscle. The following day, faint dorsalis pedis and posterior tibial pulses prompted arterial doppler and CTA, which ruled out arterial occlusion. MRI confirmed a left lower extremity DVT and she was discharged with enoxaparin.
Discussions: Balancing anticoagulation in oncologic patients post-neurosurgery is complicated by hemorrhage risk. The emergence of DVT despite initial negative imaging highlights the need for continuous assessment and preventive strategies, particularly in rehabilitation settings where mobility issues are prevalent.
Conclusions: Rehabilitation for oncology patients should address thromboembolic risks with early detection and preventive strategies to optimize mobility and recovery.
