Patient was 16 years old who presented with constant abdominal pain in the right iliac fossa with 30 hours of evolution and isolated vomiting.
On the previous days, the patient reported having had nonspecific discomfort in the right atrium without notice of edema or heat.
The date of the last rule was ten days before his visit to the emergency department.
The patient has had acne, treated for two months with cyproterone 50 mg and association of cyproterone acetate 2 mg with ethinylestradiol 35 μg.
No other relevant background.
On physical examination, only pain upon deep palpation of the right iliac fossa stands out, without signs of peritoneal irritation.
Since the diagnosis of perforated echo is complete, an analytical test is performed, except for the ipsilateral vein and vein with high sensitivity, with a value of 9958 ng/ml, and a common abdominal ultrasound of the iliac vein.
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With the diagnosis of thrombosis of the inferior vena cava, the imaging study was completed with computerized tomography (CT) signs of dilatation of the lower pulmonary artery, whose findings are compatible with filling defects in both pulmonary lobes of the right ventricle.
The findings are compatible with a more severe pulmonary thromboembolism (PTE).
Abdominal CT shows the caudal extension of the thrombus to the inferior vena cava.
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The patient is treated with subcutaneous low molecular weight heparin and has a favorable clinical course.
A study of thrombophilia as the only alteration was performed, with an antigenic protein S level of 19% (normal reference value above 54%).
