title: Picture Quiz: Abdominal Pain in a patient receiving low molecular weight heparin.
abstract: A 63 year old lady with known ischaemic heart disease was admitted to hospital with cardiac sounding chest pain. Blood pressure was 161/80 on admission, and full examination was unremarkable. ECG showed ischaemic changes in the inferior leads, and a diagnosis of unstable angina was made. Troponin I was undetectable. She was treated with subcutaneous Enoxaparin 1.5mg/kg and an intravenous nitrate infusion. Her pain settled the following day, allowing the nitrate infusion to be weaned off, although the Enoxaparin treatment was continued, pending a cardiology opinion. On the third day after admission she collapsed on the ward with a blood pressure of 95/59mmHg; examination revealed lower abdominal tenderness with a mass in the right iliac fossa. Blood tests showed that her haemoglobin had dropped by 5 grams/decilitre,she underwent urgent abdominal ultrasound followed by CT.
authors.forename: U
authors.initials: U
authors.lastname: Nandy
authors.forename: G I
authors.initials: GI
authors.lastname: Varughese
authors.forename: N
authors.initials: N
authors.lastname: Iqbal
authors.forename: T J
authors.initials: TJ
authors.lastname: Constable