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Acute pulmonary embolism complicated by thrombolytic therapy.

A 38-year-old woman presented with acute onset of chest pain, shortness of breath, and hemoptysis. She reported that she had been receiving thrombolytic and anticoagulation therapy in the previous 3 weeks for the diagnosis of thrombotic formation of the left common femoral vein secondary to a traumatic injury to the hip and lower extremity in a car accident. Examination on admission showed normal blood pressure, electrocardiograms, and chest radiograph, but subnormal arterial oxygen tension. Contrast-enhanced computed tomographic arteriography with thoracic coronary remodeling revealed an embolus in the lower right pulmonary artery causing incomplete obstruction of the artery (Fig. 1, arrow). Doppler ultrasonography confirmed the previous diagnosis of thrombotic formation of left common femoral vein, but the size of the thrombus was only about two-fifths of the previous one detected 3 weeks earlier, which supported the presumption that the embolus of pulmonary embolism originated from deep venous thrombus fragments of the thrombolytic therapy. To prevent pulmonary embolism from occurring again, an inferior vena caval filter was placed. After continuous anticoagulation therapy with low molecular weight-heparin and warfarin, the pulmonary embolus of the patient disappeared completely, but the residual femoral vein thrombosis did not change further for the better significantly. The filter was retrieved 2 months later. No new thromboembolic event occurred during a 4-month follow-up period. Pulmonary embolism is an acute and potentially lethal condition, the diagnosis of which remains difficult. It usually originates from deep vein thrombosis of the lower extremities. Systemic thrombolytic treatment for acute deep vein thrombosis may not only improve shortand long-term clinical outcomes but also increase the risk of acute pulmonary embolism as indicated by this case. The optional and preferable solution to this complication is placement of an inferior vena caval filter early enough. Submitted for publication July 9, 2008. Accepted for publication July 22, 2008. Copyright © 2010 by Lippincott Williams & Wilkins From the Changhai Hospital, The Second Military Medical University, Shanghai, China. Address for reprints: Zhaofan Xia, MD, PhD, Changhai Hospital, The Second Military Medical University, Shanghai, China.