Author(s): Magdalena Cielecka-Prynda1 (ABDEF), Ma?gorzata Kobusiak-Prokopowicz1 (ABDEF),Jacek Kurcz2 (BD), Krzysztof ??tkowski3 (DEF), Andrzej Mysiak1 (ADE
A 23-year-old student using oral contraceptives was admittedto hospital due to dyspnea at rest and tachypnea accompaniedby tachycardia and hypotonia. Echocardiography revealed ri-ght ventricular overstrain with pulmonary hypertension. CTangiography of the pulmonary arteries showed massive pulmo-nary embolism. Due to a high-risk condition, alteplase throm-bolytic treatment as well as continuous infusion with unfrac-tionated heparin were started. A Doppler ultrasound examina-tion of the lower limbs did not reveal signs of thrombosis. MRIshowed the presence of a 7 cm thrombus closing the lumenof the right external iliac vein at the level of the groin and inthe right internal iliac vein. CT of the abdominal and pelviccavities was performed, and the results revealed no contrastof the inferior vena cava and iliac veins bilaterally. Clots werealso found in the pelvic varicose venous plexus. A control MRIof the pelvic veins confirmed right external iliac vein occlusionresulting from thrombosis as well as impression of the com-mon iliac vein due to the pressure exerted by the left iliac artery.The observed radiological image suggested the possibility ofMay–Thurner syndrome. However, this hypothesis was notconfirmed as there were no significant hemodynamic distur-bances caused by the compression, lesions were greater in theright veins, there was no collateral circulation and it was hi-ghly probable that previously used oral contraception was thefactor contributing to thrombotic changes.In order to exclude potential congenital reasons for the de-scribed clinical condition, genetic tests were carried out butdid not confirm genetic prothrombotic risk. After heparintreatment, RF factor and serum lupus anticoagulant wereestablished and no abnormalities were found. Neoplasticmarker evaluation did not confirm a proliferative backgroundof thrombotic tendencies of the patient. Also, there were noirregularities in anticardiolipin or â2 glycoprotein 1 antibodies.After oral anticoagulation was discontinued, control tests ofC and S proteins as well as antithrombin III concentrationswere performed for thrombophilia, but normal values wereobtained. Due to the overall clinical condition, the patient wasrecommended not to use oral contraceptives in the future.