A 45-year-old man is evaluated in the emergency department for acute shortness of breath with right-sided chest pain. He also has a dry cough with scanty blood streaking of his phlegm. He is a nonsmoker and has no other past medical illnesses; he has just returned by airplane from Japan.
On physical examination, his temperature is 37.4°C (99.4°F), blood pressure is 102/76 mm Hg, pulse rate is 98 beats per minute, and respiration is 32 breaths per minute. D-dimer is elevated. Creatinine is 0.5. Breath sounds are clear bilaterally. There are no rhonchi auscultated. He feels soreness in the left calf and has trace left ankle edema. All peripheral pulses are intact. Anticoagulation has been started and lower extremity venous Doppler studies are positive for bilateral deep vein thromboses. What is the next step?

Question

Quizplus · Accepted Answer

The patient has bilateral deep vein thromboses and is at risk for pulmonary embolism. Placement of an inferior vena cava filter is considered when there is a high risk of embolism and anticoagulation is contraindicated or has failed.

A 45-Year-Old Man Is Evaluated in the Emergency Department for Acute