FATAL PULMONARY-EMBOLISM FROM DEEP LEG-PELVIS VEINS DURING THROMBOLYTIC TREATMENT

A 19-year-old girl had for four weeks the clinical signs of recurrent pulmonary emboli and deep-vein thrombosis (tachycardia, dyspnoea, right inguinal pain), which had been misdiagnosed. The correct diagnosis was made only after drastic deterioration in her condition following appendicectomy for falsely diagnosed appendicitis. Urokinase infusion (80,000-160,000 IU/h for 11 days) having failed to bring about improvement, 'ultra-high' thrombolysis with streptokinase was begun [250,000 IU streptokinase over 30 min, followed by 9 million IU over 6 hours). Fatal pulmonary embolism occurred seven hours after the end of the infusion. Autopsy revealed extensive separation of thrombotic material in the pelvic veins. This observation and other reports should severe as a warning against using streptokinase in ultra-high doses if large veins, as those in the pelvis, are involved.