CASE 3
A 40-year-old man (PADUA index: 4, Caprini index: 8) was confirmed as
having severe COVID-19 by a rRT-PCR test. A routine CT scan on day 3
also confirmed typical COVID-19 radiographic manifestations, as shown inFigs. 3A-3B . On admission, this patient claimed to be in good
physical health. He was however complaining of partial paralysis and an
uncomfortable feeling of his left lower limb at day 4. A bedside X-ray
showed compressed fractures in the 12th thoracic vertebrae (T12) and the
1st lumbar (L1) vertebrae (Figs. 3C-3D ). Physical examination
showed that his left lower limb was mildly swollen, the skin temperature
and skin color were normal, and the doralis pedis pulse was palpable.
Bedside US scanning showed fresh venous thrombosis in the left iliac
vein.
At the time of consultation, the patient experienced continuous lower
limb paralysis. It was decided to proceed with internal fixation surgery
of both T12 and L1 fractures. Iliac vein thrombosis however increased
the risk of PE during orthopaedicsurgery7. A
pre-operative IVCF could substantially decrease this risk. Initial
laboratory tests (Table 3 ) showed higher levels of white blood
cell count (11.89 G/L) and neutrophil count (9.35 G/L). His D-dimer
increased within 24 hours from 1.26 to 1.70 μg/mL. The hsTNI and CKMB
levels were normal.
At day 5, he was scheduled for pre-operative implantation of a
retrievable Cook Celect IVCF (William Cook, Europe). His IVCF
intervention was also performed with the aid of beside US on the
isolation ward (Figs. 3E-3G ), following the similar procedures
reported for patient 2. At day 6, he underwent orthopaedic surgery and
was transferred to his isolation post-operatively. At day 9, an X-ray
confirmed that his IVC filter had not shifted (Figs. 3H-3I ). At
day 18, another CT scan was performed which showed complete
normalisation of lung parenchyma. He recovered well from COVID-19 and
was subsequently discharged.