case_images: PMC6341253_01
case_images: (a, b) Computerized tomography angiography of the chest (axial images) showing "saddle" shaped thrombus in the pulmonary artery bifurcation extending into both trunks (arrows); (c) computerized tomography angiography of the neck (sagittal view) showing right common carotid artery bifurcation showing "saddle-shaped" thrombus in the external and internal carotid arteries (arrow); (d) digital subtraction angiography with selective right internal carotid artery injection showing middle cerebral artery inferior division occlusion (arrow); (e) magnetic resonance imaging of the brain diffusion-weighted imaging axial section showing right frontotemporal area infarction corresponding to the middle cerebral artery inferior branch occlusion.
case_images: CRIHEM2019-1585014.001.jpg
case_images: PMC6341253_01_CRIHEM2019-1585014.001.jpg
case_images: fig1
case_images: DVT and pulmonary embolism (PE) workup was completed after she developed acute shortness of breath and tachycardia with hypoxemia. DVT and subocclusive saddle-shaped PE were both noted (Figure 1), and she was started on a continuous heparin infusion. A tandem occlusion of inferior branch of the right middle cerebral artery was also noted on cerebral angiography (Figure 1).
case_images: Patient's platelet trend during hospitalization while on unfractionated heparin and bivalirudin infusion.
case_images: CRIHEM2019-1585014.002.jpg
case_images: PMC6341253_01_CRIHEM2019-1585014.002.jpg
case_images: fig2
case_images: On hospital day 7, PF4-H AB (optical density (OD) < 0.103) and SRA tests resulted negative with uptrending platelet count (105,000/microL) (Figure 2).