Thrombolytic Management of Submassive Pulmonary Embolism along with Deep Vein Thrombosis: A Case Report

Pulmonary Embolism (PE) is a life-threatening condition, often presenting with classic symptoms such as dyspnea, chest pain, and tachycardia. However, atypical presentations can obscure early recognition, particularly in intermediate-risk, submassive PE and clots in transit. The present report describes a case of a 50-year-old male automobile mechanic with uncontrolled diabetes who presented with giddiness for one week, followed by acute onset breathlessness. Clinical evaluation revealed tachycardia, tachypnea, left leg swelling, and hypoxaemia. Electrocardiography (ECG) showed Right Ventricular (RV) strain with S1Q3T3 pattern. Echocardiography revealed RV dysfunction with a Tricuspid Annular Plane Systolic Excursion (TAPSE) of 15 mm. Computed Tomography Pulmonary Angiography (CTPA) demonstrated a large saddle embolus with extension into bilateral lobar and segmental branches. The patient was thrombolysed with streptokinase, followed by an infusion of unfractionated heparin before being started on oral anticoagulants. On day four after thrombolysis, biomarkers improved significantly; CTPA showed complete resolution with marked improvement of RV dysfunction on echocardiography. The present case emphasises the importance of maintaining a high index of suspicion for PE in atypical presentations and demonstrates successful thrombolysis in an intermediate-high risk case, even with older, cost-effective agents.