Leg massage during pregnancy with unrecognized deep vein thrombosis could be life threatening: a case report
Two articles on PainSci cite Sutham 2020: 1. Massage Therapy Side Effects 2. Does Massage Increase Circulation?
PainSci commentary on Sutham 2020: ?This page is one of thousands in the PainScience.com 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 pregnant woman who fell into a coma after a traditional Thai massage at a shopping center in Chiang Mai, Thailand. Her baby miscarried. The cause was a clot in her leg, which was dislodged and carried to her lungs, where it stuck, cutting off lung circulation.
About 10 minutes after her massage, the woman developed shortness of breath, became disoriented, convulsed, lost consciousness, and had a heart attack. She was initially resuscitated at the hospital, but remained comatose, and she remained unconscious for two months until the case report was written.
“Pregnant women are at a higher risk of undetected or subtle thromboembolism…” and “it is reasonable to conclude that the patient had undetected preexisting deep vein thrombosis, which was mechanically dislodged by the massage and travelled massively to both lungs, leading to a life threatening condition.”
~ 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.
BACKGROUND: Traditional massage seems to be safe but not entirely risk free, though serious adverse events are very rare. This report is aimed at illustrating a rare but fatal presentation of massive pulmonary embolism caused by leg massage and also to encourage both massage providers and pregnant women to be aware of undetected or subtle deep vein thrombosis, which could be a life threatening condition as a consequence of leg massage.
CASE PRESENTATION: A 25-year-old primigravid Thai woman underwent massage at a traditional massage shop at 25th week of gestation. Shortly after leg and foot massage, she had a sudden onset of dyspnea, followed by consciousness alteration, brief spastic-like convulsion, became unconscious and suffered a cardiac arrest. Basic life support (BLS) at the event scene as well as during transfer and advanced cardiovascular life support (ACLS) at the hospital were provided, resulting in successful resuscitation but persistent coma. Bedside echocardiography showed poor contractility of the dilated right ventricle, and pulmonary embolism was suspected. CT angiography (CTA) revealed multiple concentric intraluminal filling defects within the right and left pulmonary arteries, indicating massive pulmonary embolism. The fetus died in utero and spontaneous labor and vaginal delivery occurred.
CONCLUSION: Leg massage in patients with deep vein thrombosis can dislodge thrombi, leading to life threatening pulmonary embolism, and should be contraindicated. Since pregnant women are at a higher risk of undetected or subtle thromboembolism, traditional massage in pregnant women should be contraindicated unless they are proven to have no such risk.
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- “Renal artery embolization after back massage in a patient with aortic occlusion,” Mikhail et al, Nephrol Dial Transplant, 1997.
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- “Massaging the outcome: an unusual presentation of pulmonary embolism,” Lim et al, BMJ Case Rep, 2009.
- “Leg massage by mother resulting in fatal pulmonary thromboembolism,” Behera et al, Med Leg J, 2018.
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