Acute pulmonary embolism caused by enlarged uterine leiomyoma: a rare presentation

Abstract

Patient: Female, 42.

Final diagnosis: Acute pulmonary embolism.

Symptoms: Chest pain • dyspnea.

Medication: Streptokinase • Warfarin.

Clinical procedure: .-

Specialty: Cardiology and Neoplasm.

Objective: Management of emergency care.

Background: Deep venous thrombosis (DVT) and subsequent pulmonary embolism (PE) caused by pelvic vein compression are rare and life-threatening complications of leiomyoma of the uterus.

Case report: We report a 42-year-old virgin woman with a history of leiomyoma who presented to the emergency department with complaints of dyspnea and pleuritic chest pain with transient spotting. On physical examination, she had a non-tender abdomen with a 20-week size uterus. Imaging investigations revealed an acute DVT in her left leg and a huge uterine-derived mass compressing the common iliac veins. Transesophageal echocardiography (TEE) demonstrated an echogenic mass in her right pulmonary artery consistent with thrombosis. The patient was completely cured using thrombolytic therapy and myomectomy, and was well at 1 year after thrombolysis.

Conclusions: PE caused by pelvic vein compression is a rare complication of leiomyoma, which should be considered. Thrombolytic therapy associated with myomectomy can be implemented for treating such cases, and TEE can be used for diagnosing suspected high-risk PE.

Keywords: Echocardiography; Leiomyoma; Pulmonary Embolism; Thrombolytic Therapy.

Figure 1.

A clot in the right pulmonary artery diagnosed by transesophageal echocardiography. AO – aorta, MPA – main pulmonary artery, RPA – right pulmonary artery.

Figure 2.

Uterine leiomyoma and the compression of both common iliac veins. The arrows show the venous compression (white arrows) and the uterine mass (black arrows).