case_images: PMC11283792_01
case_images: Pedigree of the studied family. Filled symbols represent thrombotic events. The age (yo: years old) of the thrombotic events is between brackets. The arrow points the proband. The prothrombotic genetic defects identified in each subject (all heterozygous) are also indicated.
case_images: JBM-15-305-g0001.jpg
case_images: PMC11283792_01_JBM-15-305-g0001.jpg
case_images: f0001
case_images: At the age of 3, he was diagnosed of hereditary AT deficiency type I (AT activity: 47%, AT antigen: 40%) (reference range 80-120%), mild free and total PS deficiency (45% both) (reference range 70-120%) and prothrombin variant G20210A in heterozygosis, due to the broad thrombotic family history (Figure 1).
case_images: CT angiography findings at diagnosis. (A) Thrombosis in the left iliac vein that appears in the IVC; (B) Thrombosis in the left iliac vein without clear compression syndrome at the crossing behind the right iliac artery; (C) PE in branches of the right basal pyramid artery.
case_images: JBM-15-305-g0002.jpg
case_images: PMC11283792_01_JBM-15-305-g0002.jpg
case_images: f0002
case_images: Abdominal computed tomography (CT) showed a DVT in the left lower limb, reaching the proximal inferior vena cava (IVC) and occupying 50% of the contralateral iliac vein at the confluence area, with moderate soft tissue edema. Also, the thoracic CT angiography findings were compatible with acute segmental PE (Figure 2). 
case_images: Phlebography from the posterior tibial vein. (A) Before rt-PA infusion: occupation of the deep tibial, popliteal and femoral venous territory, with little drainage through the superficial vein territory; B and (C) Following rt-PA infusion: permeability of the posterior tibial, popliteal, femoral, iliac and cava venous system.
case_images: JBM-15-305-g0003.jpg
case_images: PMC11283792_01_JBM-15-305-g0003.jpg
case_images: f0003
case_images: A multi-side-hole infusion USACDT was placed within the thrombosed segment from the iliac to the distal popliteal (Figure 3). 
case_images: CT angiography findings 9 months following the initial diagnosis: complete resolution of the PE.
case_images: JBM-15-305-g0004.jpg
case_images: PMC11283792_01_JBM-15-305-g0004.jpg
case_images: f0004
case_images: Nine months later, the angio-CT revealed total resolution of the PE (Figure 4).