Thrombotic pulmonary embolism of inferior vena cava during caesarean section: A case report and review of the literature

Figure 1 The dynamic process of inferior vena cava thrombus. The images obtained from transthoracic echocardiography during caesarean section (CS); the time is displayed in the upper left corner; the dotted line outlines the thrombus. A: Inferior vena cava (IVC) was normal before CS; B: A nascent IVC thrombus appeared after placental removal during CS; C-E: The thrombus grew rapidly and extended to the tricuspid valve orifice in a serpentine manner; F: The thrombus moved to the tricuspid valve orifice; G: The thrombus detached from the heart; H: A partial thrombus was seen in the right main pulmonary artery. IVC: Inferior vena cava; LA: Left atrium; RA: Right atrium; LV: Left ventricle; RV: Right ventricle; RPA: Right pulmonary artery; LPA: Left pulmonary artery; MPA: Main pulmonary artery.

Figure 2 Chest computed tomography angiography after caesarean section. A: Right main pulmonary artery embolism; B: Right main pulmonary artery embolism and inferior branch embolism; C: Left lower branch pulmonary artery embolism (as shown by the arrow).

Figure 3 Cardiac volume and dynamics indexes at perioperative period of caesarean section. A: Cardiac volume and dynamics indexes by transthoracic echocardiograph; B: Cardiac volume and dynamics indexes by hemodynamic monitoring. “1” represents 20 min before laparotomy; “2” represents after suction amniotic fluid; “3” represents after removal of the fetus; “4” represents after removal of placenta; “5” represents after uterine suture; “6” represents after abdominal closure; “7” represents postoperative day. EDV: End diastolic volume; ESV: End systolic volume; SV: Stroke volume; LVEF: Left ventricular ejection fraction; TR: Tricuspid regurgitation; PASP: Pulmonary arterial systolic pressure; CVP: Central venous pressure; SaO2: Oxygen saturation by pulse oximetry; HR: Heart rate; SBP: Systolic blood pressure; DBP: Diastolic blood pressure.