Bignon, Mathieu

Dahdouh, Ziad

Grollier, Gilles

Roule, Vincent

English

Via Medica Journals

701www.cardiologyjournal.orgIMAGES IN CARDIOLOGYCardiology Journal2011, Vol. 18, No. 6, pp. 70110.5603/CJ.2011.0038Copyright © 2011 Via MedicaISSN 1897–5593Address for correspondence: Dahdouh Ziad, MD, Cardiology Department, University Hospital of Caen,Avenue Cote de Nacre, 14033 Caen, France, tel: 06 29 36 22 32, fax: 09 57 20 80 76, e-mail: ziad_dahdouh@hotmail.comReceived: 15.03.2011 Accepted: 30.05.2011Massive pulmonary embolism arising from a bifidovarian vein in a patient with protein S deficiencyMathieu Bignon, Ziad Dahdouh, Vincent Roule, Gilles GrollierCHU de Cean, Department of Cardiology, Cean, F-14000, FranceA 36 year-old woman was admitted to the in-tensive care unit for sudden onset of dyspnea andnear-syncope. She had resting tachypnea, tachycar-dia, blood pressure of 110/70 mm Hg and oxygensaturation of 90% on room air. There was no evi-dence of clinical thrombophlebitis of lower limbs.The ECG showed sinus tachycardia, incompleteright bundle branch block and non-specific T waveabnormalities. Cardiac ultrasound highlighted en-largement of the right ventricle (EDRVD > 30 mm)and elevated troponin Ic at 0.44 µg/L, n < 0.04.The protocol for computed tomography con-sisted of an evaluation of the pulmonary arteries,abdomen, pelvis and lower limbs down to and in-cluding the popliteal vein. It showed large intralu-minal thrombi in both right and left pulmonary ar-teries and their division branches (Fig. 1), and iden-tified partially fixed thrombi in the bifid left ovarianvein (Fig. 2). The patient received intravenous an-ticoagulation therapy based on therapeutic doses ofstandard heparin. She tolerated the medication, andshowed a significant improvement in her cardio-pulmonary status. Her embolic episode was relatedto an estroprogestative related protein S deficien-cy. She was discharged on warfarin and is current-ly doing well without functional compromise.AcknowledgementsThe authors do not report any conflict of inte-rest regarding this work.Figure 1. Computed tomography of chest demonstra-ting large emboli in main right pulmonary artery (arrow)and left inferior lobar pulmonary artery (arrow head).Figure 2. Computed tomography of abdomen showingextensive thrombi in left bifid ovarian vein (arrows).Left renal vein is permeable (arrow head).

Massive pulmonary embolism arising from a bifid ovarian vein in a patient with protein S deficiency

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Massive pulmonary embolism arising from a bifid ovarian vein in a patient with protein S deficiency

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