Subacute Massive Pulmonary Embolism Treated With Streptokinase

Subacute massive pulmonary embolism occurs insidiously over weeks, has a high mortality rate, and may be less amenable to systemic thrombolysis. It is associated with a high likelihood of the development of pulmonary hypertension. The subacute presentation makes it difficult to diagnose leading to treatment delays and poor clinical outcomes. We present a case of a 40-year-old man with unprovoked pulmonary embolism and no evidence of deep vein thrombosis. The patient underwent systemic thrombolysis with streptokinase and was given long-term oral anticoagulants. A dramatic clinical recovery was seen along with significant clearance of the thrombus.