Key result
Catheter-directed thrombus fragmentation and thrombolysis successfully treated severe acute pulmonary embolism in a postpartum patient presenting with left ventricle dilatation.
Why the study?
Diagnosing pulmonary embolism in maternity is challenging due to overlapping symptoms and radiation concerns, and caesarean section nearly doubles this lethal postpartum risk.
Case Report (n=1)
No
Dilated left ventricular echocardiography cannot rule out postpartum acute pulmonary embolism, and catheter-directed angiography can be a crucial diagnostic and therapeutic tool in life-threatening scenarios.
Echocardiographic LV dilatation should not exclude postpartum PE; case report leaves open the utility of catheter-directed intervention.
Background Pulmonary embolism is a lethal complication during pregnancy and puerperium. Compared to vaginal delivery, caesarean section has almost twice the pulmonary risk. The diagnosing of pulmonary embolism can be challenging because of the overlapping symptoms and signs in maternity, and also the clinician should balance the benefits and risks of radioactive examinations. Case presentation: A 31-year-old nulliparous female underwent caesarean section for a separated symphysis pubis. Right after the operation, the patient developed abrupt dyspnea and dull pain whitin the left back region, and her cardiopulmonary function deteriorated rapidly. Venous ultrasound confirmed left common iliac vein occlusion, and transthoracic echocardiogram revealed a relatively normal right heart and dilated left ventricle with patent foramen ovale. Pulmonary angiography confirmed the diagnosing of acute embolism. Then, catheter-directed thrombus fragmentation and thrombolysis were performed. The patient recovered quickly, and the echocardiogram results were normal a month later. Conclusions Dilated left ventricular echocardiography cannot rule out postpartum acute pulmonary embolism. In some extreme emergency scenarios, when acute PE is the most likely diagnosis (a life-threatening condition), catheter-directed angiography can be performed instead of other radioscopies.
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Song et al. (2022) conducted a case report in Acute pulmonary embolism (n=1). Catheter-directed thrombus fragmentation and thrombolysis was evaluated on Clinical recovery and echocardiogram normalization. Catheter-directed thrombus fragmentation and thrombolysis successfully treated severe acute pulmonary embolism in a postpartum patient presenting with left ventricle dilatation.
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