Modern Management of Massive Pulmonary Emboli and Concurrent Grade III Splenic Laceration

Pulmonary embolism (PE) is a leading cause of cardiovascular mortality. Active hemorrhage complicates management by limiting the use of thrombolytic therapy.

A 59-year-old woman presented after a syncopal episode and fall. Imaging revealed massive bilateral PE and a grade III splenic laceration. Standard anticoagulation and thrombolysis were contraindicated. The Pulmonary Embolism Response Team (PERT) guided care, including catheter-directed thrombectomy with significant hemodynamic improvement, followed by splenic artery coil embolization. An inferior vena cava filter was placed while anticoagulation was temporarily withheld. Once stabilized, anticoagulation was resumed, and the filter was later removed. The patient achieved full recovery during follow-up.

The management of this patient required weighing the risk of hemorrhage against the need for urgent reperfusion. The decision to pursue catheter-directed thrombectomy followed by embolization allowed for hemodynamic recovery while minimizing bleeding risk.

Individualized strategies and PERT-coordinated multidisciplinary care are essential for optimal outcomes in high-risk, complex PE presentations.