Massive Acute Pulmonary Embolism in A Pregnant Patient Who Underwent Thrombolytic Treatment in Emergency Service

Öz

Acute pulmonary embolism (APE) is one of the most important preventable mortality causes during pregnancy. In this case report, a 24-week pregnant patient who were diagnosed with APE and who underwent thrombolytic treatment was discussed in the light of a literature review. The 27-year-old female patient, who was pregnant, applied to the emergency service with sudden shortness of breath and chest pain. Since the hemodynamic condition of the patient was unstable, no imaging could be carried out in the radiology unit. As a result of the right ventricular load symptoms detected in bedside Transthoracic Echocardiography (ECO), massive APE was diagnosed, and thrombolytic treatment was initiated. APE should be considered in patients who are admitted to emergency services with sudden shortness of breath and chest pain complaints. Patients who are excessively unstable for imaging in the radiology unit should be evaluated quickly with bedside transthoracic ECO in terms of massive embolism.

Anahtar Kelimeler

• Acute pulmonary embolism
• Pregnancy
• Thrombolytic treatment

Acil Serviste Trombolitik Tedavi Uygulanan Gebe Hastada Massif Akut Pulmoner Emboli

Öz

Akut pulmoner emboli (APE), gebelik döneminde en önemli önlenebilir ölüm nedenlerinden birisidir. Bu yazıda APE tanısı alan ve trombolitik tedavi uygulanan 24 haftalık gebe bir hastayı litaratür eşliğinde tartışılmıştır. Gebe olan 27 yaşındaki bayan hasta, ani başlayan nefes darlığı ve göğüs ağrısı şikayetleriyle acil servise müracaat etti. Kan tetkik sonuçları gebelikteki fizyolojik değişikliklerle karışması nedeniyle yol gösterici olmadı, yapılan bilateral alt ekstremite venöz doppler ultrasonografi (USG)’de tromboz izlenmedi. Hastanın hemodinamik durumu unstabil olduğundan radyoloji ünitesinde herhangi bir görüntüleme yapılamadı. Yatakbaşı transtorasik ekokardiyografi (EKO)’de sağ ventrikül yüklenme bulguları görülmesi sonucu massif APE tanısı konularak trombolitik tedavi uygulandı. APE, hemodinamik olarak unstabil olan hastalarda kardiyovasküler acil durumların en yaygın nedenlerinden birisi olup, çok mortal seyreder. Ani başlayan nefes darlığı ve göğüs ağrısı şikayetleriyle acil servise başvuran hastalarda, mutlaka APE düşünülmelidir. Radyoloji ünitesinde görüntüleme yapılamayacak kadar unstabil olan hastalar, hızlıca yatakbaşı transtorasik EKO ile massif emboli açısından değerlendirilmelidir.

Anahtar Kelimeler

• Akut pulmoner emboli
• Gebelik
• Trombolitik tedavi

Kaynakça

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