SHM Converge Scientific Abstract ePoster Gallery-Recurrent Pulmonary Embolism and Post-Thrombectomy Ards in a Minimally Provoked Young Patient

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This case describes a 38-year-old woman with minimal prior medical history who developed an unusually severe venous thromboembolism after recent foot surgery and postoperative immobility. She presented with progressive dyspnea, and imaging revealed a large saddle pulmonary embolism, bilateral lower-lobe thrombi, right ventricular strain, and bilateral deep vein thromboses. Although her risk factors suggested a provoked event, the burden and severity of thrombosis were atypical for her age, making a thrombophilia evaluation reasonable; this workup was negative.<br /><br />She underwent an initial interventional radiology suction thrombectomy, which removed extensive clot and reduced pulmonary arterial pressure significantly. Despite this, she clinically worsened in the MICU with confusion and hypoxemia. Repeat imaging showed recurrent saddle pulmonary embolism with pulmonary infarction, consistent with persistent thrombus burden, clot propagation, or fragmentation after the first procedure. A second suction thrombectomy was performed, and an infrarenal IVC filter was placed.<br /><br />Her course was further complicated by acute respiratory distress syndrome, likely related to reperfusion injury after restoration of blood flow. She required intubation, mechanical ventilation, and intermittent proning for 72 hours. Anticoagulation was challenging because she had a subtherapeutic response to unfractionated heparin, raising concern for heparin resistance. She was transitioned to enoxaparin and later to a direct oral anticoagulant for more reliable anticoagulation during this high-risk period.<br /><br />Overall, the case highlights the importance of close post-thrombectomy monitoring, prompt reassessment when deterioration occurs, and awareness of complications such as recurrent embolism, reperfusion-related ARDS, and anticoagulation resistance. Timely multidisciplinary management ultimately led to gradual recovery, extubation, and discharge in stable condition.

Asset Subtitle

Akanksha Malepati

Meta Tag

Author List Akanksha Malepati, Dana Tomalty, Kiyoshi Scissum, Roger Smalligan, Soumyadeep Bag

Category Clinical Vignettes

Concept Pulmonary Embolism

Concept Thrombophilia Evaluation

Concept Post-Thrombectomy Monitoring

Concept Anticoagulant Management

Concept Venous Thromboembolism

Distinguished Non-Finalist

Presenter Organization UAB Heersink School of Medicine

Presenting Author Akanksha Malepati

Track Adult

Keywords

venous thromboembolism

saddle pulmonary embolism

deep vein thrombosis

suction thrombectomy

right ventricular strain

pulmonary infarction

acute respiratory distress syndrome

IVC filter

heparin resistance

direct oral anticoagulant

Pulmonary Embolism

Thrombophilia Evaluation

Post-Thrombectomy Monitoring

Anticoagulant Management

Venous Thromboembolism