Case report: a challenging case of bilateral pulmonary embolism, deep venous thrombosis and bleeding uterine fibroids in a resource poor setting in Ghana

Abstract

We present a case of a 41-year-old woman previously diagnosed with uterine fibroids, who presented with sudden onset chest pain and breathlessness and severe bleeding per vaginam. A CT Pulmonary Angiogram showed bilateral pulmonary emboli with right basal lung infarction and a Doppler ultrasound revealed deep venous thrombosis of the right femoral and popliteal veins. Ultrasound of the pelvis showed submucosal and intramural uterine fibroids. The challenge of treatment with this patient was treatment of her venous thromboembolism in the presence of her bleeding uterine fibroids. The patient was started on therapeutic dose SC enoxaparin. She subsequently underwent total abdominal hysterectomy with early mobilization, reinstitution of SC enoxaparin 6 hours post-op and full anticoagulation with warfarin 3 days after surgery. This case highlights the challenges with such a case in a resource poor setting.

Keywords

• pulmonary embolism
• uterine fibroids
• deep venous thrombosis
• low resource setting
• ghana