[Fatal pulmonary embolism after lysis therapy in post-traumatic renal vein thrombosis]

A 30-year-old man was hospitalized because of increasing dyspnoea for 4 weeks. Chest X-ray demonstrated an infiltrate in the right upper lobe and enlargement of the central pulmonary arteries. Lung perfusion scintigraphy revealed, typical of embolism, absent perfusion of the entire right upper lobe, as well as segmental embolism in the left upper and basal lobes. Phlebography of the legs and pelvis was unremarkable. Intravenous heparin treatment was begun (initially 1,250 IU/h, then dosage adjusted according to the partial thromboplastin time). Nonetheless the patient's condition deteriorated the next day and the respiratory failure increased (pO2 61 mm Hg despite oxygen supply). Streptokinase was then infused in ultra-high dosage, 9 million units over 6 hours. But the patient died of cardiocirculatory failure 4 hours after the streptokinase infusion had been finished. Autopsy revealed fulminant recurrent pulmonary embolism with occlusion of the right main pulmonary artery. The emboli had their origin in renal vein thrombosis extending into the inferior vena cava, which had probably been caused by slight trauma to the flank during a game of squash 6 weeks previously.