CTICasesMassive Bilateral Pulmonary Embolism Post Oral Contraceptive Pill
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Imaging findings
A 15-year-old girl on oral contraceptive pills developed sudden collapse. CT pulmonary angiography (CTPA) demonstrated extensive bilateral occlusive thrombi in the pulmonary arteries, associated with signs of pulmonary infarction and bowing of the interventricular septum, indicating acute right heart strain. Post-thrombolysis CTPA showed significant recanalization of the pulmonary artery lumens and resolution of septal bowing, despite persistent clot burden.
Key takeaways
Oral contraceptive pills are a significant risk factor for pulmonary embolism, even in adolescents. Massive PE can lead to acute right ventricular dysfunction and pulmonary infarction. Thrombolysis is an effective treatment for massive PE, capable of rapid recanalization and improvement in cardiac hemodynamics, though patients may still experience complications related to initial cardiopulmonary arrest and resuscitation.
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