Thrombus risk versus bleeding risk: a clinical conundrum.
BMJ Case Rep
; 12(3)2019 Mar 08.
Article
em En
| MEDLINE
| ID: mdl-30852504
ABSTRACT
A 62-year-old man presented to the Emergency Department with dyspnoea and central pleuritic chest pain radiating posteriorly to between the scapulae. His medical history included hypertension, osteoporosis and chronic kidney disease secondary to focal segmental glomerulosclerosis with relapsing nephrotic syndrome. Significant examination findings included a loud palpable P2 and a displaced apex beat. An ECG revealed sinus tachycardia with a right-bundle branch block and p-pulmonale. A CT pulmonary angiogram and aortogram demonstrated extensive bilateral pulmonary emboli and a descending thoracic aortic dissection. Subsequent ultrasound of the lower limbs confirmed an extensive, non-occlusive deep vein thrombosis in the right calf. Management of this patient involved therapeutic anticoagulation and tight blood pressure control, with plans for surgical repair delayed due to worsening renal impairment and subsequent supratherapeutic anticoagulation. Co-existence of an aortic dissection and PE has been rarely described and optimal management remains unclear.
Palavras-chave
Texto completo:
1
Bases de dados:
MEDLINE
Assunto principal:
Embolia Pulmonar
/
Glomerulosclerose Segmentar e Focal
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Trombose Venosa
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Dissecção Aórtica
/
Síndrome Nefrótica
Tipo de estudo:
Etiology_studies
/
Risk_factors_studies
Limite:
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
BMJ Case Rep
Ano de publicação:
2019
Tipo de documento:
Article
País de afiliação:
Austrália