Multiple Deep Vein Thrombosis.

A 46-year-old woman with a history of abnormal vaginal bleeding and who was taking oral contraceptive pills presented to the emergency department complaining of pain in her upper and lower extremities. Three weeks previously, she had experienced pain and swelling in her left lower extremity. Ten days previously, she had experienced left neck pain and facial swelling, but the symptoms disappeared a few days later. She subsequently experienced pain in her left upper extremity. Contrast-enhanced computed tomography (CT) showed deep vein thrombosis (DVT) in the internal jugular vein with extension to the left brachiocephalic and subclavian veins (Picture A and B). The CT scan also showed pulmonary embolism (Picture C), DVT in the left lower extremity, and the mass of an endometrial carcinoma (Picture D). Hormone replacement therapy and cancer increase the risk of multiple vein thrombosis (1, 2). She stopped taking the contraceptive pills, and anticoagulation therapy was initiated.

Picture.