Case 3
A 14-year-old Caucasian female (BMI 31.3 kg/m2)
presented with a two week duration of bilateral chest pain and shortness
of breath. Chest CTA was performed that revealed bilateral PE (see
Figure 3). Ultrasound evaluation of the lower extremities did not reveal
DVT. Echocardiogram showed no evidence of cor pulmonale. Thrombophilia
evaluation was negative. She had been taking norgestimate-ethinyl
estradiol (0.25 mg-35 mcg) for 3 months to regulate her menstrual
periods. Patient received Enoxaparin for 3 months, with repeat CTA
showing residual thrombosis at the bifurcation of the descending right
pulmonary artery. Recommendations were made to continue therapeutic
anticoagulation for an additional three months and to reassess thrombus
resolution with repeat chest CTA.