medigraphic.com
Federación Mexicana de Ginecología y Obstetricia, A.C.

2019, Number 07

<< Back Next >>

Ginecol Obstet Mex 2019; 87 (07)

Pulmonary thromboembolism secondary to enormous uterine fibroid: medical-surgical management. A case report

Gabasa-Gorgas L, Benito-Vielba M, Ortega-Marcilla S, del Tiempo-Marques MP, Yagüe-Moreno H, Bolea-Tobajas R

Language: Spanish
References: 18
Page: 489-495
PDF size: 860.66 Kb.


ABSTRACT

Background: Uterine fibroids are the most common benign tumor in premenopausal women. Most of them do not generate symptoms; however, they can produce serious systemic problems due to the compression of vital structures.
Clinical Case: A 42-year-old woman, Nuligest, anemia secondary to heavy menstrual bleeding due to myomatous uterus. She consulted for dyspnea of great efforts and progressive asthenia, chest pain in left hemithorax of pleuritic-mechanical profile and palpitations. Blood pressure 128/47. Heart rate 133, O2 Saturation 92%. Non-painful mass in hypogastrium. Not edema or signs of deep vein thrombosis. In the complementary explorations we found: D-Dimer 7455, Electrocardiogram: Sinus tachycardia at 125 bpm. Right bundle hemiblock, Computed angiotomography: Acute bilateral pulmonary thromboembolism Doppler lower extremities: external iliac femoral veins and thrombus-free popliteal, probable compression of the iliac veins by myoma, TC: Polimyomatous uterus, in anteversion, of 200 mm. Compression of inferior cava venous in iliac prebifurcation zone with partial thrombosis of right iliac venous. We Placed a lower vena cava filter with a diagnosis of secondary pulmonary thromboembolism due to compression by a enormous uterine fibroid. A hysterectomy and bilateral salpingectomy by laparotomic was performed. Pathological anatomy: uterus of 1900 g, 200 x 180 x 110 mm with multiple subserous and intramural nodules. At 5 months, the patient is asymptomatic.
Conclusions: Large myomas (1000 g) should be considered a risk factor for venous thromboembolism due to external compression of the iliac veins.


REFERENCES

  1. Nishikawa H, et al. Deep venous thrombosis and pulmonary thromboembolism associated with a huge uterine myoma- -a case report. Angiology 2000;51(2):161-6. https://doi. org/10.1177/000331970005100210

  2. Olaf M, et al. Deep venous thrombosis. Emerg Med Clin North Am 2017;35(4):743-770. https://doi.org/10.1016/j. emc.2017.06.003.

  3. Bagot CN, et al. Virchow and his triad: a question of attribution. Br J Haemotol 2008t;143(2):180-90. https://doi. org/10.1111/j.1365-2141.2008.07323.x

  4. Fletcher H, et al. Venous thromboembolism as a complication of uterine fibroids: A retrospective descriptive study. J Obstet Gyneacol 2009;29(8):732-736. https://doi. org/10.3109/01443610903165545

  5. Pavone D, et al. Epidemiology and risk factors of uterine fibroids. Best Pract Res Clin Obstet Gyneacol 2018;46:3-11. https://doi.org/10.1016/j.bpobgyn.2017.09.004

  6. De la Cruz MS, et al. Uterine fibroids: diagnosis and treatment. Am Fam Physician 2017;15;95(2):100-107. https://pdfs.semanticscholar.org/2d01/22a7aec04a18ca 89f3b6e2d02c7ad53d1228.pdf

  7. Srettabunjong S. Systemic thromboembolism after deep vein thrombosis caused by uterine myomas. Am J Forensic Med Pathol 2013;34(3):207-209. https://doi.org/10.1097/ PAF.0b013e318298a456

  8. Rosenfeld H, et al. Lower extremity deep venous thrombosis with fatal pulmonary thromboembolism caused by benign pelvic space-occupying lessions- an overview. Am J Forensic Med Pathol 2012;57(3):665-668.

  9. Moulder JK, et al. Management considerations for patients with uterine fibroids and concurrent venous thromboembolismurrent. Curr Opin Obstet Gynecol 2016;28(4):329- 335. https://doi.org/10.1097/GCO.0000000000000286

  10. Lacharite-Roberge AS, et al. Case series of seven women with uterine fibroids associated with venous thromboembolism and chronic thromboembolic disease. Pulm Circ 2019;9(1):2045894018803873. https://doi. org/10.1177/2045894018803873

  11. Shiota M, et al. Deep-vein thrombosis is associated with large uterine fibroids. Tohoku J Exp Med 2011;224:87-89.

  12. Hung HK, et al. Increased risk of venous thromboembolism in women with uterine leiomyoma: a nationwide, population- based case-control study. Acta Cardiol Sin 2018;34:66-76. https://doi.org/10.6515/ ACS.201801_34(1).20170901B

  13. Dagur G, et al. Urological complications of uterine leiomyoma: a review of literature. Int Urol Nephrol 2016;48(6):941- 8. https://doi.org/10.1007/s11255-016-1248-5.

  14. Idowu BM, et al. Ultrasonographic characterisation of obstructive uropathy in Nigerian women with uterinefibroids. Niger Postgrad Med J 2018;25(4):220-224. https://doi. org/10.4103/npmj.npmj_122_18.

  15. Mihmanli V, et al. Giant cervical myoma associated with urinary incontinence and hydroureteronephrosis. Clin Exp Obstet Gynecol 2015;42(5):690-1.

  16. Fernandes FL, et al. Uterine myoma as a cause of iliac vein thrombosis and pulmonary embolism: common disease, rare complication. Respirol Case Rep 2014;2(4):132-4. https://doi.org/10.1002/rcr2.79

  17. Cărbunaru A, et al. Extensive left iliac veins and inferior vena cava thombosis revealing a giant uterine myoma. Rom J Intern Med 2016;54(1):70-3. https://doi.org/10.1515/ rjim-2016-0009

  18. Caparelli ML, et al. Unusual causes of venous thombosis: bladder distensión and uterine mass. Ann Vasc Surg 2018;46:370.e9-370.e12. https://doi.org/10.1016/j. avsg.2017.08.046.




2020     |     www.medigraphic.com