[Sudden exercise dyspnea in a young woman - an interdisciplinary case in the emergency room]

A 39-year-old woman with suddenly occurring exercise dyspnea is admitted under the suspicion of pulmonary embolism. In medical history, she mentions a recently completed fertility treatment.

Clinically, the patient is in good condition. D-dimers and hCG are markedly elevated. Sonography reveals pronounced ascites, a large right-sided pleural effusion and multicystic, clearly enlarged ovaries. In conjunction with medical history and confirmed by the gynecologists, the diagnosis of ovarian hyperstimulation syndrome (OHSS) is made, classified as grade II-III (moderate to severe).

Thrombembolic prophylaxis with Certoparin 3000 IU/d is established as sole therapy. The course of the disease is self-limited.

OHSS is primarily a gynaecological condition, but physicians may encounter it with exercise dyspnea or abdominal pain as presenting symptoms. Symptoms can be treated well at an early stage, and severe courses can usually be prevented. In this case, clinical history and sonography could disprove the initially suspected diagnosis of pulmonary embolism.