Age: 36.0
Sex: F
Vaccine: COVID19
Symptoms: Pain in extremity, Peripheral swelling, Red blood cell sedimentation rate increased, Skin discolouration, Skin tightness
Clinical narrative: Patient is a 36 yo female with history of IVDU, Hep C, fibromyalgia who presents with left leg pain and swelling found to have significant left leg DVT now s/p femoropopliteal vein thrombectomy.   HPI:  Patient is a 36 y.o. female with history of IVDU, Hep C, fibromyalgia who presents with left leg pain and swelling.   Patient woke up this morning with her entire left leg being painful, swollen, "tight", and "achy" throughout. She had been experiencing 1 week of left leg pain, followed by an acute worsening in the last 2 days. She denies any recent travel or leg trauma.   She denied any fevers, chills, SOB, or chest pain. She denies any new tattoos, recent malignancies, or blood clotting disorders. Of note, she is currently undergoing evaluation for lupus due to fatigue and rashes.   Per her IVDU, she injects heroin in her arm (last use 1 month ago after 4 years of sobriety), and is currently on methadone. This pain is different from her fibromyalgia.   Of note, she got her first Moderna COVID vaccine last week.     Highlights of ED course: Pertinent exam findings: tachycardia, marked LLE swelling (mid thigh 70 cm vs 64 cm on RLE) Warm bilateral LE, palpable pulses Important data gathered: LENI: left deep vein thrombosis extending from common femoral vein to distal posterior tibial veins, ESR 47, CRP 58, elevated d-dimer > 4000 Key treatments administered: heparin gtt, oxyodone 5 mg for pain, vascular medicine, cardiology consult   Patient was subsequently evaluated by vascular medicine, who brought her to cath lab for venography and endovenous intervention. She went to the cath lab. U/s guided access to L popliteal vein with micropuncture. J-wire into L CIV, serial dilation and placement of 12F sheath. Multiple passess with Penumbra lightning aspiration catheter. Femoropopliteal vein with restored patency, continued organized clot in iliac vein, infusion of 6mg TPA with 10 min dwell time. Further passages of aspiration catheter. Decision to leave 30 cm infusion cath.    When seen on the floor, patient was hemodynamically stable. Still with pain in lower extremities and back. No chest pain or SOB.     #DVT, s/p vascular surgery thrombectomy 2 days of acute left leg pain and swelling. Initial exam notable for purplish LLE in ED. LENIs notable for left DVT extending from CF vein to distal PT veins. Vascular evaluated and performed femoropopliteal vein thrombectomy with restored patency, continued organized clot in iliac vein, infusion of 6mg TPA with 10 min dwell time. Further passages of aspiration catheter. Decision to leave 30 cm infusion cath. On OCPs but no known other risk factors (quit smoking), suggesting unprovoked DVT. Other potential etiology includes venous congestion. Hypercoaguable w/u pending. Notably, Moderna vaccine 1 week ago, although limited evidence suggesting relation between mRNA vaccine and increased thrombosis risk. Hypercoagulability workup was sent. Patient transitioned from heparin to apixaban for discharge with vascular medicine and vascular surgery followup