Document Type
Conference Proceeding
Publication Date
5-3-2024
Abstract
Pulmonary embolism is a life-threatening condition that most commonly occurs due to the embolization of deep venous thrombus in the lower limbs, arising from a constellation of risk factors that affect the flow, stasis, or coagulability of blood. Stasis is an important mechanism and is the primary factor in venous obstruction and long-haul flights. We present a case of a young woman who experienced pulmonary embolism due to venous compression in the pelvis from a massive leiomyoma. A 30-year-old female presented to the emergency department with dyspnea and palpitations lasting for a duration of 2 days. She had a past medical history of recently provoked deep vein thrombosis, poorly compliant with Apixaban, uterine leiomyoma with menorrhagia, iron deficiency anemia, and Factor VII deficiency. Tachycardia was noted at presentation, along with a palpable, nontender mass in the hypogastric region of the abdomen. Due to a high Wells score, a CTA PE was performed, revealing a large saddle pulmonary embolism with an RV:LV ratio of 2. Echocardiography demonstrated an enlarged IVC with less than 50% respiratory variation. She underwent PE thrombectomy and was initiated on IV Heparin. Lower extremity venous Doppler revealed acute DVT in the left distal femoral vein. A CT venogram of the abdomen and pelvis showed an enlarged uterus with leiomyomas, the largest one measuring 13.7x10.2cm. The leiomyoma was compressing the common iliac vessels and inferior vena cava. She was not considered a candidate for venous stenting due to the risk of stent stenosis from leiomyoma compression. Moreover, she was contemplating myomectomy, which could relieve the obstruction. While an IVC filter could decrease the risk of future pulmonary embolism, especially from DVT in the lower limbs, it was not performed as the IVC was dilated which increases the risk of dislodgement. Anticoagulation was switched to Apixaban, and she was discharged from the hospital with plans to discuss myomectomy for uterine leiomyoma. While Factor VII deficiency could potentially result in thrombosis in a small proportion of patients due to the overexpression of other clotting factors, she had associated heavy menstrual bleeding with normal levels of other clotting factors. This suggests that Factor VII deficiency is unlikely to be one of the causes of VTE in this patient. This case illustrates the risk posed by venous obstruction in the development of deep vein thrombosis and subsequent pulmonary embolism. Timely intervention for pelvic masses can prevent potentially life-threatening pulmonary embolism.
Recommended Citation
Gyawali P, Jha P, Yadav SK, Skrzynski J. Uterine leiomyoma: rare cause of pulmonary embolism. Presented at: American College of Physicians Michigan Chapter and Society of Hospital Medicine Michigan Chapter 2024 Resident and Medical Student Day, 2024 May 3; Troy, MI
Comments
American College of Physicians Michigan Chapter and Society of Hospital Medicine Michigan Chapter 2024 Resident and Medical Student Day, May 3, 2024, Troy, MI