Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Am J Emerg Med. 2010 Feb;28(2):254.e3-4. doi: 10.1016/j.ajem.2009.05.016.
A 63-year-old white woman with a history of hypertension, hyperlipidemia, hypothyroidism, and transient ischemic attack, on Premarin, presented with a 2-week history of worsening edema and pain on the left side of the lower extremity associated with purplish discoloration and decreased temperature after a prolonged car travel. Physical examination revealed 2+ edema from the midthigh to the toes associated with purpuric discoloration. All arterial pulses were 4+. Ultrasound examination demonstrated an acute deep vein thrombus extending from the external iliac veins down throughout the visualized veins of the left calf. The patient was started on intravenous heparin and underwent venogram with subsequent thrombolysis. After 48 hours of alteplase infusion, balloon angioplasty was performed and 2 stents were placed in the left common and external iliac veins. Premarin was discontinued and she remains on oral anticoagulation with Coumadin. The patient did well clinically and a second ultrasound showed interval improvement. There is significant family history but no personal history of thrombotic events; however, thrombophilia evaluation is unremarkable.
一位 63 岁白人女性，有高血压、高血脂、甲状腺功能减退和短暂性脑缺血发作病史，服用倍美力，因长时间乘车后左下肢疼痛和肿胀加剧并伴有紫绀和温度降低，出现 2 周病史。体格检查发现从大腿中部到脚趾有 2+水肿，伴有紫绀。所有动脉脉搏均为 4+。超声检查显示急性深静脉血栓形成，从髂外静脉延伸至整个左小腿可见静脉。患者开始接受静脉内肝素治疗，并进行血管造影和随后的溶栓治疗。阿替普酶输注 48 小时后，进行了球囊血管成形术，并在左股总静脉和髂外静脉内放置了 2 个支架。停用倍美力，改用华法林口服抗凝治疗。患者临床情况良好，第二次超声显示间隔改善。有明显的家族史，但无个人血栓形成史；然而，血栓形成倾向评估无异常。
