Two-edged Knife: Massive Pulmonary Embolism and Thrombolytic Contraindication

İntroduction: Pulmonary embolism is a common cause of death among emergency department admissions, and it has a high mortality and morbidity rate. Etiological reasons are generally associated with immobility. Radiological imaging methods are at the forefront in diagnosis. Anticoagulant and thrombolytic therapy may be preferred in treatment according to the hemodynamic condition of the patient. Case report: A 56-year-old female patient admitted to the emergency department with sudden onset of dyspnea and syncope with a condition of cardiogenic shock, and echocardiography revealed an enlargement of the right heart chambers and impaired functions, and a tomography was performed with the pre-diagnosis of pulmonary embolism. When systemic thrombolytic therapy was contraindicated in the patient who had embolism on tomography, catheter-based thrombectomy and selective low-dose thrombolytic therapy to the pulmonary artery were administered. The patient, who became hemodynamically stable and his shock condition improved, was discharged with anticoagulant therapy. Conclusion: When left untreated, pulmonary embolism is a disease with a high mortality rate. Although systemic thrombolytic treatments are contraindicated in some patients, successful results can be obtained with locally effective interventional treatments in these patient groups. Keywords: Pulmonary embolism, catheter-based thrombolysis, thrombolytic therapy