Two Cases of Early-Onset Asymptomatic Pulmonary Embolism Following Arthroscopic Rotator Cuff Repair

Arthroscopic rotator cuff repair is a widely used minimally invasive surgical procedure, and venous thromboembolism after this surgery is considered uncommon compared to lower extremity operations. Nevertheless, rare but serious events may occur, and asymptomatic cases can be easily overlooked. We present two elderly female patients who underwent arthroscopic rotator cuff repair in the lateral decubitus position with upper extremity traction and postoperative intravenous patient-controlled analgesia. Both were considered low risk by conventional evaluation, with Wells pulmonary embolism scores of zero and routine preoperative investigations performed about four weeks before surgery showing no abnormalities. Despite the absence of typical respiratory symptoms, mild oxygen desaturation prompted D-dimer testing, which was markedly elevated in both cases. Computed tomography angiography confirmed asymptomatic pulmonary embolism in the early postoperative period, accompanied by deep vein thrombosis in the lower extremities. Both patients were successfully treated with direct oral anticoagulant therapy, leading to favorable outcomes without recurrence. These cases demonstrate that asymptomatic pulmonary embolism can occur early after arthroscopic rotator cuff repair, even in patients assessed as low risk. D-dimer testing in response to subtle oxygen desaturation may facilitate timely diagnosis, and vigilant monitoring with comprehensive risk assessment is essential to improve patient safety.