Factor V Leiden Mutation Accompanying Recurrent Massive Pulmonary Thromboembolism

A 46-year-old female patient was admitted to the emergency department with the complaints of dyspnea, swelling of the right leg and and feeling of unwell. Deep venous thrombosis was detected at the lower extremity venous Doppler ultrasound and thrombi was detected at the left main pulmonary artery and at the segmental pulmonary arteries bilaterally with the computed tomography of thorax. As hypotension was developed, she was diagnosed with pulmonary thromboembolism and treated with streptokinase infusion. The patient's complaint of dyspnea decreased and her haemodynamic parameters improved after thrombolytic therapy, and subsequently she underwent anticoagulant therapy. On the fifth day of monotorization, while still under the anticoagulant therapy, the patient suddenly developed dyspnea, cyanosis and hypotension. The rt-PA therapy was adminestered with the pre-diagnosis of recurrent massive pulmonary thromboembolism. After the rt-PA therapy, the patient's haemodynamics improved, her cyanosis and complaints of dyspnea regressed. Heterozygote Factor V Leiden mutation was detected with examinations. Inferior vena cava filter was placed together with the anticoagulant therapy. The patient has been under our monitoring for 3 months.