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A 32 year old woman, at 25 weeks of her first pregnancy, presented with massive acute pulmonary embolism with haemodynamic instability. She required fibrinolysis, ventilatory support, and vasoactive drugs. Anticoagulation was started (enoxaparin 1 mg/kg twice daily). During her admission to the intensive care unit, lower limb Doppler ultrasound showed a left popliteal venous aneurysm which had a maximum diameter of 4.5 cm and was 7 cm long, compressible, with minimal remaining parietal thrombus. The study was completed using magnetic resonance angiography (Fig. 1A and B). Conservative management with enoxaparin (1 mg/kg twice daily) was selected and the pregnancy continued without complications. Enoxaparin was discontinued at week 38 of pregnancy to induce labour, and subsequently re-introduced after 8 hours of delivery. The medication will be maintained until consideration of surgery once the patient finishes breastfeeding.
Figure 1(A) T2 STIR morphological sequence. (B) TWIST time resolved 3D sequence, MIP reconstruction.
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