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Massaging the outcome: an unusual presentation of pulmonary embolism

PainSci » bibliography » Lim et al 2009
Tags: harms, massage, case, pain problems, manual therapy, treatment

Two articles on PainSci cite Lim 2009: 1. Massage Therapy Side Effects2. Does Massage Increase Circulation?

PainSci commentary on Lim 2009: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

This is a case study of a man who’d had deep vein thrombosis presumably caused by a long-haul flight (flex your ankles regularly on flights!). He was treated with anticoagulants for months, but the clot remained… until it was dislodged in a massage two years later. The massage was a “full-body” massage and included the legs, but no other details were noted. “The onset of dyspnoea soon after leg massage suggests that this was the likely cause of thrombus embolisation.” It does seem likely.

His only symptom was shortness of breath, which is impressive considering how serious the embolus was. It was a “worm-shaped right atrial embolus, most probably a femoral cast.” Meaning the embolus was basically the shape of the vessel where it had lived until it was dislodged, and wormed its way into a lung. Shudder.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

A 56-year-old man with a previous deep vein thrombosis presented with dyspnoea after a leg massage. A transthoracic echocardiogram demonstrated a "worm-shaped" right atrial embolus, most probably a femoral cast. A pulmonary artery angiogram confirmed a large wedge-shaped perfusion defect caused by a pulmonary embolus. There are previous case reports about leg massage causing pulmonary emboli but this is the first reported event where the thrombus has been visualised directly. Also, it demonstrates the important role that echocardiography plays in pulmonary embolus.

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