title: Upper extremity deep venous thrombosis and pulmonary embolus after ovarian hyperstimulation.
abstract: A healthy female presented with upper extremity (UE) swelling of several days duration. Admission laboratories were normal except for an elevated D-dimer. An UE ultrasound with Doppler revealed a thrombus in the right subclavian vein. A subsequent chest CT angiogram further characterised the subclavian vein thrombus and also identified a pulmonary embolus. A thorough history and laboratory evaluation showed that her only risk factors were long-time contraceptive pills and a recent cycle of ovarian hyperstimulation (OH) 7 weeks prior to presentation. Anticoagulation treatment was started and the patient's remaining outpatient work-up was negative for all other hereditary causes. A complete anatomic work-up showed bilateral thoracic outlet syndrome (TOS). A review of the literature on the occurrence of upper extremity deep venous thrombosis suggests that these usually occur in the presence of a predisposing factor, including catheters, indwelling devices and active malignancies. OH has been shown to precipitate venous thromboembolism events; however, the diagnosis of bilateral TOS as a predisposing risk factor has not been described in a patient who had recently undergone recent OH and in one who was not actively pregnant.
authors.affiliation: George Washington University Hospital, Washington, District of Columbia, USA.
authors.forename: Anne Catherine Miller
authors.initials: AC
authors.lastname: Cramer
authors.affiliation: Department of Pulmonary and Critical Care, George Washington University Hospital, Washington, District of Columbia, USA.
authors.forename: Anna Warszawa
authors.initials: AW
authors.lastname: McLean
authors.affiliation: Department of Pulmonary and Critical Care, George Washington University Hospital, Washington, District of Columbia, USA.
authors.forename: Jalil
authors.initials: J
authors.lastname: Ahari
mesh_terms: D000328:Adult; D000072226:Computed Tomography Angiography; D003937:Diagnosis, Differential; D065427:Factor Xa Inhibitors / Q000627:therapeutic use; D005260:Female; D006801:Humans; D010062:Ovulation Induction / Q000009:adverse effects*; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D000069552:Rivaroxaban / Q000627:therapeutic use; D013350:Subclavian Vein / Q000000981:diagnostic imaging; D018615:Ultrasonography, Doppler, Color; D056824:Upper Extremity Deep Vein Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*
chemical_list: D065427:Factor Xa Inhibitors; D000069552:Rivaroxaban