Post-operative Unexpected Bilateral Massive Pulmonary Embolism in a Thirty-Year-Old Woman: A Case Report

Abstract

Pulmonary embolism (PE) is a rare, yet serious complication. That, generally follows invasive procedures in adults. The present report details the case of bilateral pulmonary embolism in a thirty-year-old women after ovarian cyst surgery. A thirty-year-old female patient, who had ovarian cystectomy ten days previously, consulted the emergency department with the complaints of sickness and syncope. Her blood pressure, pulse and respiratory rate were 90/40 mmHg, 150/min. and 35/min, respectively. During examination and phlebotomy, she had a cardiac arrest and responded to a 3-minute cardiopulmonary resuscitation (CPR) with tracheal intubation. During imaging procedures, she had three further cardiac arrests and was admitted to the intensive care unit. The preliminary diagnoses were acute renal failure (ARF) and PE. Fluid replacement, inotropic support, anticoagulant therapies, as well as sedation to prevent brain damage were started immediately. Thrombolytic therapy was not attempted because she had surgery ten days ago and hematoma was observed on abdominal ultrasound. Inhaled nitric oxide and inhaled iloprost with sildenafil were employed to reduce pulmonary hypertension. When discharged 136 days after hospitalization she was a tracheotomized and, spontaneously breathing home care patient with hypoxic brain injury. Early detection and treatment of PE are of great importance for a good prognosis and prevention of life-threatening complications.

Keywords

• Massive pulmonary embolism
• inhaled nitric oxide
• iloprost
• sildenafil