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A complication of hip surgery
  1. S G Williams1,
  2. P Currie1,
  3. D W Galvani2
  1. 1Department of Cardiology, Arrowe Park Hospital, Wirral, UK
  2. 2Department of Haematology
  1. Correspondence to:
 Dr Simon G Williams, Department of Cardiology, Arrowe Park Hospital, Arrowe Park Road, Upton, Wirral CH49 5PE, UK;
 drsgwilliams{at}hotmail.com

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A 53 year old woman presented with right sided pleuritic chest pain four weeks after a total hip replacement. Prophylactic low molecular weight heparin had been given perioperatively for four days. Clinical examination revealed a swollen tender left calf and a pleural rub at the right base on auscultation of the chest. Vascular Doppler scanning of the left leg revealed a deep vein thrombosis. A clinical diagnosis of pulmonary embolism was made and before starting the patient on low molecular weight heparin for treatment, a full blood count was performed. This revealed a haemoglobin concentration of 134 g/l, white cell count 7.6 × 109/l, and platelets 17 × 109/l.

QUESTIONS

  1. What is the likely diagnosis?

  2. Which test should be recommended to confirm the diagnosis?

  3. What treatment should be offered for the pulmonary embolism?

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