Pulmonary aspiration thrombectomy with Lightning Flash catheter in a young patient with fibrosing mediastinitis

We present the case of a 33-year-old patient with atypical pulmonary anatomy secondary to fibrosing mediastinitis who underwent pulmonary thrombectomy with the Lightning Flash aspiration catheter following a pulmonary embolism triggered by tibial osteomyelitis. Despite an inconclusive computed tomography angiography report, the diagnosis was made through clinical evaluation associated with electrocardiographic and echocardiographic changes. Angiography was crucial for diagnosis. The procedure was technically successful, resulting in immediate improvement in pulmonary artery systolic pressure and dyspnea. This case demonstrates the feasibility of aspiration thrombectomy in distorted anatomies and underscores the importance of early intervention in intermediate- to high-risk pulmonary embolism.