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.