Acute pulmonary embolism right after caesarean section despite left ventricle dilatation: A case report and literature review

Background: Pulmonary embolism is a lethal complication during pregnancy and puerperium. Compared to vaginal delivery, caesarean section has almost twice the pulmonary risk. The diagnosing of pulmonary embolism can be challenging because of the overlapping symptoms and signs in maternity, and also the clinician should balance the benefits and risks of radioactive examinations. Case presentation: A 31-year-old nulliparous female underwent caesarean section for a separated symphysis pubis. Right after the operation, the patient developed abrupt dyspnea and dull pain whitin the left back region, and her cardiopulmonary function deteriorated rapidly. Venous ultrasound confirmed left common iliac vein occlusion, and transthoracic echocardiogram revealed a relatively normal right heart and dilated left ventricle with patent foramen ovale. Pulmonary angiography confirmed the diagnosing of acute embolism. Then, catheter-directed thrombus fragmentation and thrombolysis were performed. The patient recovered quickly, and the echocardiogram results were normal a month later. Conclusions Dilated left ventricular echocardiography cannot rule out postpartum acute pulmonary embolism. In some extreme emergency scenarios, when acute PE is the most likely diagnosis (a life-threatening condition), catheter-directed angiography can be performed instead of other radioscopies.