Dual clinical dilemmas in late pregnancy: A multidisciplinary conservative approach to high-risk pulmonary embolism with persistent category III fetal status

Figures

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  Fig. 1. Exhibiting the laboratory results during the patient’s admission to the hospital.

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  Fig. 2. Frontal chest radiograph demonstrates. The cardiomediastinal silhouette is within normal limits, with a normal cardiothoracic ratio and preserved cardiac borders. Lung fields show mildly increased bronchovascular markings without focal consolidation, pleural effusion, or pneumothorax. Notably, there is prominence of the right descending pulmonary artery, which appears enlarged and more conspicuous compared to the contralateral side (highlighted by a white arrow).

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  Fig. 3. CT pulmonary angiography demonstrates a large saddle embolus (white arrow) at the bifurcation of the main pulmonary artery extending into both right (Green dot) and left pulmonary arteries, with further propagation into proximal lobar and segmental branches.

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  Fig. 4. The thrombi show classic polo mint appearance (central filling defect surrounded by contrast) allocated with white arrow.

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  Fig. 5. There is associated evidence of right heart strain, including right ventricular dilatation with probable interventricular septal bowing with increased RV/LV RATIO.

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  Fig. 6. Nonstress test that was done while the patient was admitted to the ICU, which showed a recurrent spontaneous deceleration despite intrauterine resuscitation, there are multiple NST strips with the same findings.

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  Fig. 7. Nonstress test that was done at the day of discharge, which showed a reactive category 1.

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  Fig. 8. A timeline table showcasing the clinical course of the patient’s condition during her hospitalization.