Images in Clinical Medicine
Postpartum Venous Thromboembolism
N Engl J Med 2008; 359:2706December 18, 2008
- Article
A previously healthy 34-year-old woman, gravida 7, para 5, presented on postpartum day 14 with severe low back pain, chest pain, dyspnea, and substantial swelling of both legs after an uneventful cesarean section, performed with combined spinal–epidural anesthesia. During that period she was bedridden. Examination of the pelvis and legs with Doppler ultrasonography revealed bilateral deep venous thrombosis extending to the iliac veins. A computed tomographic (CT) scan of the abdomen and pelvis showed the thrombus extending through the inferior vena cava and both ovarian veins (Panel A, arrowheads). A CT scan of the chest showed pulmonary embolism in the right lung (Panel B, arrow). The patient was treated with low-molecular-weight heparin together with oral warfarin, and her symptoms were alleviated. She was found to be heterozygous for a mutation in the gene encoding for 5,10-methylenetetrahydrofolate reductase (MTHFR). Since no other cause for her symptoms was detected, the mutation may have been the source of her susceptibility to hypercoagulation. She was doing well at a follow-up visit 3 months after admission but did not return to the clinic again.
Ronen Zalts, M.D.
Tony Hayek, M.D.
Rambam Medical Center, Haifa 31096, Israel
r_zalts@rambam.health. gov. il - Citing Articles (1)
Citing Articles
1
Stoll, Paul, Virchow, J. Christian, Lommatzsch, Marek, . (2009) Postpartum Venous Thromboembolism. New England Journal of Medicine 360:15, 1574-1574
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