Acute Pulmonary Thromboembolism Immediate Aftermath of Childbirth in a Pregnant Patient with a Huge Uterine Myoma

Abstract

A 32-year-old pregnant woman, gravida 2, para 1, with an enlarged uterine myoma, were admitted to our hospital with stronger feeling of abdominal tightness at 30th weeks of pregnancy. The cesarean was performed under ordinary prevention of thrombus as high risk group according to Japanese venous thromboembolism prevention guideline at the 37th pregnant week. The patient suddenly complained of syncope at first walking after childbirth. Computed tomography revealed multiple pulmonary thromboembolism and compressed pelvic veins and a huge solid mass in the pelvis, probably a myoma. There were also mild bilateral hydronephrosis and a large thrombosis in the femoral and common iliac veins, and inferior vena cava. The treatment with anticoagulation and thrombolytic therapy was successfully cleared the multiple pulmonary thrombi. After the 8th week of childbirth, there was little improvement in uterine myoma size. It was decided that surgical removal of a huge uterine myoma was indicated to eradicate the etiology ofthe continued venous compression. With a temporary inferior vena cava filter preoperatively, the uterine leiomyomectomy was performed with an uneventful recovery, and then the patient was discharged. We describe a pregnant woman who had stasis of the pelvic venous system secondary to compression by a huge uterine myoma without any other identifiable risk factors for the development of deep venous thrombosis and pulmonary thromboembolism. The existence of deep venous thrombosis associated with a huge uterine myoma may often require inferior vena cava filter as well as elastic stocking, intermittent pneumatic compression and intravenous injection of heparin.