Case of a young woman successfully operated on for acute pulmonary embolism and right ventricular thrombus after urogenital infection

The authors report a case of a 22-year-old women operated on for pulmonary embolism with success. The venous embolism developed in two phases one week apart. The first clinical sign was a dyspnea of abrupt onset limiting physical activity even after a mild exertion. However, relevant diagnostic tests were performed after one week when the patient fainted, her dyspnea worsened. The results of ECG, echocardiography and pulmonary perfusion scintigraphy indicated the presence of a thrombus residing in the right ventricle and the embolism of the right pulmonary artery. Chest CT and pneumo-angiography findings show the embolus completely blocking the main right branch of the pulmonary artery and partially blocking the left lower lobe artery. On the basis of their experiences published earlier the patient was brought to a stable cardio-respiratory state prior to surgery. Both the adherent right ventricular thrombus and the fresh embolus residing in the right branch of the pulmonary artery were removed under the protection of extracorporeal circulation. After the elapse of an event-free 6-month postoperative period the patient continued to remain symptomless, while being on a long-term anticoagulant regimen. The long-term anticoncipient medication and the urogenital infection 3 months prior to surgery may have been involved in the etiology of the pulmonary embolism. The authors propose the implementation of an antithrombotic prophylaxis in young women after gynecological infections.