Aspiration Thrombectomy for High-Risk Pulmonary Embolism With Life-Threatening Anemia and Active Uterine Bleeding: A Case Report.
Okba Saoudi, Bu Wang
✦ AI-curated · Sources linked
Case in brief
A 48-year-old woman presented with shock, critical anemia (hemoglobin 41 g/L), and ongoing uterine bleeding associated with adenomyosis. CT pulmonary angiography showed bilateral pulmonary emboli, including occlusion of the right pulmonary artery main trunk; echocardiography found severe pulmonary hypertension, and ultrasound showed extensive left-leg deep vein thrombosis. Because active bleeding contraindicated thrombolysis, she underwent emergency percutaneous aspiration thrombectomy and inferior vena cava filter placement. Pulmonary artery pressure fell from 51/23 to 34/12 mm Hg. With transfusion, gynecologic treatment, and titrated anticoagulation, she was stable and free of dyspnea at discharge, with hemoglobin 72 g/L.
What made this case unusual
The case combined high-risk pulmonary embolism with life-threatening anemia and active uterine bleeding, precluding thrombolysis; aspiration thrombectomy was used as a rescue approach with palliative rather than curative intent.
Diagnostic / clinical pearl
In this case, active uterine bleeding made thrombolysis contraindicated despite hemodynamically unstable pulmonary embolism. Aspiration thrombectomy with vena cava filter placement provided an alternative rescue approach, alongside coordinated management of bleeding, anemia, and anticoagulation.
Why it matters
This single case illustrates a possible approach to a complex thrombolysis-contraindicated presentation, but cannot establish comparative safety or efficacy.