Pulmonary embolism and infarction in the setting of factor V Leiden mutation
Presentation
Right sided thoracic pain. SpO2 95%. Diminished breath sounds on the lower right.
Patient Data
Bilateral pulmonary embolism of multiple segmental and subsegmental arteries especially at the inferior lobes and the middle lobe. At the right lower lobe medial segment there is complete occlusion of the segment artery and its branches, with peripheral pulmonary opacification visible on lung window setting.
Case Discussion
Factor V Leiden mutation is a known risk factor for deep vein thrombosis and pulmonary embolism. This patient had been diagnosed with this condition 14 years before. He had had another pulmonary embolism 2 years ago, and was subsequently prescribed an oral anticoagulant, the factor Xa inhibitor rivaroxaban, which however the patient discontinued after a few months because of alleged side effects. Current pulmonary angiogram CT shows multiple thrombi bilaterally, with complete vessel occlusion at the right lower lobe medial segment, leading to pulmonary infarction at this site. The patient was treated with another factor Xa inhibitor (apixaban) and recovered fully within the next few weeks.
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