PMC6341253_01
(a, b) Computerized tomography angiography of the chest (axial images) showing "saddle" shaped thrombus in the pulmonary artery bifurcation extending into both trunks (arrows); (c) computerized tomography angiography of the neck (sagittal view) showing right common carotid artery bifurcation showing "saddle-shaped" thrombus in the external and internal carotid arteries (arrow); (d) digital subtraction angiography with selective right internal carotid artery injection showing middle cerebral artery inferior division occlusion (arrow); (e) magnetic resonance imaging of the brain diffusion-weighted imaging axial section showing right frontotemporal area infarction corresponding to the middle cerebral artery inferior branch occlusion.
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fig1
DVT and pulmonary embolism (PE) workup was completed after she developed acute shortness of breath and tachycardia with hypoxemia. DVT and subocclusive saddle-shaped PE were both noted (Figure 1), and she was started on a continuous heparin infusion. A tandem occlusion of inferior branch of the right middle cerebral artery was also noted on cerebral angiography (Figure 1).
Patient's platelet trend during hospitalization while on unfractionated heparin and bivalirudin infusion.
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On hospital day 7, PF4-H AB (optical density (OD) < 0.103) and SRA tests resulted negative with uptrending platelet count (105,000/microL) (Figure 2).