Pulmonary embolism from persistent dilatation of the bladder secondary to anticholinergic side effects

Deep vein thrombosis and pulmonary embolism secondary to urinary retention: a case report

Background

Pulmonary embolism occurs when a blood thrombus forms and travels from a vein in the body to an artery in the lung. Thrombi often develop in one of the deep veins of the legs, thighs, or pelvis, a condition known as deep vein thrombosis. In this report, we describe a rare instance of a patient who developed deep vein thrombosis and pulmonary embolism secondary to urinary retention, and we also review some of the literature.

Case presentation

A 75-year-old Japanese man visited our hospital with the complaint of lower extremity weakness. A physical examination revealed bilateral leg edema. Contrast-enhanced computed tomography showed thrombi in both the bilateral intrapelvic veins and the right pulmonary artery, with an extremely distended bladder. We diagnosed deep vein thrombosis and pulmonary embolism due to urinary retention, which was attributed to detrusor insufficiency owing to both taking an anticholinergic drug and neurogenic bladder. The patient was immediately started on both management of voiding dysfunction and anticoagulant therapy.

Conclusions

We encountered a patient with deep vein thrombosis and pulmonary embolism secondary to urinary retention that could have been fatal. In such cases, clinicians should always take into account appropriate management of voiding dysfunction.

Implications of a 5-liter urinary bladder: inferior vena cava syndrome leading to bilateral pulmonary artery emboli

Compression of the inferior vena cava by the distended urinary bladder is rare but is usually found in the presence of lower extremity edema. Here, we present the case of a 68-year-old man found to have multiple pulmonary emboli as the first manifestation of inferior vena cava compression from a distended urinary bladder 5 L in capacity.

Lower extremity deep venous thrombosis with fatal pulmonary thromboembolism caused by benign pelvic space-occupying lesions--an overview

Venous stasis predisposes to thrombosis. One hundred and sixty cases of fatal pulmonary thromboembolism were reviewed to determine how many cases had deep venous thromboses associated with venous blood flow reduction caused by external pressure from benign pelvic masses. Three cases were identified, representing 2% of cases overall (3/160): a 44-year-old woman with a large uterine leiomyoma (1048 g); a 74-year-old man with prostatomegaly and bladder distension (containing 1 L of urine); and a 70-year-old man with prostatomegaly and bladder distension (containing 3 L of urine). Although a rare cause of fatal deep venous thrombosis and pulmonary thromboembolism, space-occupying pelvic lesions can lead to extrinsic pressure on adjacent veins reducing blood flow and causing stasis and thrombosis. Individuals with large pelvic masses may, therefore, be at increased risk of pulmonary thromboembolism from deep venous thrombosis, particularly in the presence of concurrent risk factors such as immobility, thrombophilias, malignancy, and significant cardiopulmonary disease.

Acute pulmonary embolism induced by renal obstruction with benign prostatic hyperplasia: Case report

Background

We report a rare case of acute pulmonary embolism (PE) induced by urinary retention and bladder distention with benign prostatic hyperplasia (BPH).

Case report

A 76-year-old male with BPH presented to the hospital with anuria of 24 h duration and abdominal distention. Physical examination revealed tenderness and distention of the lower abdomen and a swollen right leg. Echocardiography after urethral catheterization showed a large free-floating thrombus traversing back and forth through the tricuspid orifice. Computed tomographic angiography demonstrated filling defects at the level of the right inter lobar pulmonary artery and the segmental branches of both pulmonary arteries, indicating acute PE. The patient was treated with heparin and warfarin for three weeks to ensure the resolution of the pulmonary embolus. After the resolution of all symptoms, the patient was discharged without further complication.

Conclusion

This case suggested that a distended bladder is a potential risk factor for the development of deep vein thrombosis and PE.