[Systemic lysotherapy using recombinant tissue plasminogen activator for fulminant pulmonary embolism].

A 44-year-old woman sustained massive pulmonary embolization from a deep leg-vein thrombosis. She was given 70 mg recombinant tissue plasminogen activator (rt-PA) by continuous intravenous drip over two hours. Before this treatment perfusion scintigraphy had demonstrated complete absence of flow in the right lung due to embolic occlusion of the central hilar vessels. In addition there were several segmental filling defects in the left lung. Even during the two-hour infusion the circulatory state began to improve, as did echo- and electrocardiographic signs of acute right heart strain. Correspondingly there was a rapid raise in arterial pO2. Another scintigraphy after 48 hours revealed almost complete reperfusion of the right lung and the left lung segments. This case demonstrates that infusion of rt-PA can be an effective and relatively risk-free method of treating haemodynamically significant massive lung embolism, even in comparison with selective or systemic thrombolysis with urokinase or streptase or with surgical embolectomy.