DVT and pulmonary embolism with stroke

Excerpt

An 86-year-old woman tripped over her dog fracturing her right femur and left ankle; she had operative repair of her femur but conservative treatment with immobilization of the ankle injury and received 6 weeks of subcutaneous heparin for prevention of deep venous thrombosis (DVT). One week later she noticed soreness in her right thigh and became acutely dyspneic when walking to the bathroom. On arrival at the hospital she was tachycardic and tachypneic, requiring high-flow oxygen to maintain her oxygen saturation above 90 %. Bilateral proximal pulmonary emboli (PE) were diagnosed by chest CT angiography (Fig. 1) and a heparin infusion was started. A transthoracic echocardiogram (TTE) demonstrated right ventricular dilation with leftward bowing of the interventricular septum, moderate-severe tricuspid regurgitation, and elevated pulmonary artery pressures. Based on these findings, tissue plasminogen activator (TPA) was given intravenously since no contraindications were present. Additionally, duplex ultrasonography found she had DVT of her right femoral and left popliteal veins.

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