High-risk acute pulmonary embolism as a complication of pelvic venous thrombosis in a student using oral contraception; a suspicion of May–Thurner syndrome – a case report
Journal Title: Ginekologia i Położnictwo medical project - Year 2016, Vol 4, Issue 42
Abstract
A 23-year-old student using oral contraceptives was admitted to hospital due to dyspnea at rest and tachypnea accompanied by tachycardia and hypotonia. Echocardiography revealed right ventricular overstrain with pulmonary hypertension. CT angiography of the pulmonary arteries showed massive pulmonary embolism. Due to a high-risk condition, alteplase thrombolytic treatment as well as continuous infusion with unfractionated heparin were started. A Doppler ultrasound examination of the lower limbs did not reveal signs of thrombosis. MRI showed the presence of a 7 cm thrombus closing the lumen of the right external iliac vein at the level of the groin and in the right internal iliac vein. CT of the abdominal and pelvic cavities was performed, and the results revealed no contrast of the inferior vena cava and iliac veins bilaterally. Clots were also found in the pelvic varicose venous plexus. A control MRI of the pelvic veins confirmed right external iliac vein occlusion resulting from thrombosis as well as impression of the common iliac vein due to the pressure exerted by the left iliac artery. The observed radiological image suggested the possibility of May–Thurner syndrome. However, this hypothesis was not confirmed as there were no significant hemodynamic disturbances caused by the compression, lesions were greater in the right veins, there was no collateral circulation and it was highly probable that previously used oral contraception was the factor contributing to thrombotic changes. In order to exclude potential congenital reasons for the described clinical condition, genetic tests were carried out but did not confirm genetic prothrombotic risk. After heparin treatment, RF factor and serum lupus anticoagulant were established and no abnormalities were found. Neoplastic marker evaluation did not confirm a proliferative background of thrombotic tendencies of the patient. Also, there were no irregularities in anticardiolipin or â2 glycoprotein 1 antibodies. After oral anticoagulation was discontinued, control tests of C and S proteins as well as antithrombin III concentrations were performed for thrombophilia, but normal values were obtained. Due to the overall clinical condition, the patient was recommended not to use oral contraceptives in the future.
Authors and Affiliations
Magdalena Cielecka-Prynda, Małgorzata Kobusiak-Prokopowicz, Jacek Kurcz, Krzysztof Łątkowski, Andrzej Mysiak
Keywords
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