Description
A 44-year-old African-American woman presented to the emergency department with chest pain and shortness of breath of 12 hours prior to presentation. Her medical history includes antithrombin deficiency, recurrent deep venous thrombosis (DVT), recurrent pulmonary emboli, poorly controlled hypertension, diabetes mellitus, asthma, inferior vena cava filter placement, pulmonary hypertension and bipolar disorder. Her surgical history includes bilateral pulmonary thromboendarterectomy 3 months prior to presentation. She reported non-compliance to Coumadin. She smokes half a pack per day for the last 25 years. Family history is positive for multiple early deaths secondary to thromboembolic complications.
Physical examination showed tachycardia with heart rate of 105 beats per minute. Chest examination was significant for bilateral rales at the lung bases. ECG showed sinus tachycardia, cardiac troponins were negative and international normalised ratio was 1.08. Venous duplex of the lower extremities showed chronic DVT.
Chest CT scan with contrast showed an occlusion of the left...
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