Management of a massive pulmonary embolism in a pregnant patient with mechanical fragmentation followed by delayed catheter-directed thrombolysis in the early postpartum period.
There are limited data available on the management of massive pulmonary embolism in pregnancy. The use of systemic thrombolysis has been reported, but there are few documented cases on the use of mechanical fragmentation or catheter-directed thrombolysis. Systemic thrombolysis in pregnancy increases the risk of major hemorrhage and there are reports of massive subchorionic hematomas following its use. We describe the use of mechanical fragmentation and optional retrievable inferior vena cava (IVC) filter insertion in a 38-week pregnant woman followed by delayed pharmacological catheter-directed thrombolysis during the early postpartum period to successfully treat a massive pulmonary embolism.
O'Keeffe
S A
SA
Department of Radiology, St James's Hospital, Dublin, Ireland. sylviaokeeffe@yahoo.co.uk
McGrath
A
A
Ryan
J M
JM
Byrne
B
B
D000328:Adult; D002404:Catheterization / Q000379:methods; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D049590:Postpartum Period / Q000187:drug effects; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000000981:diagnostic imaging / Q000188:drug therapy*; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000188:drug therapy*; D011859:Radiography; D015912:Thrombolytic Therapy / Q000379:methods*
D005343:Fibrinolytic Agents