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

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.