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Area of Science:

  • Vascular Medicine
  • Diagnostic Imaging
  • Thrombosis Research

Background:

  • Pulmonary embolism (PE) is a serious condition often requiring anticoagulation.
  • Unexplained peripheral masses and edema can complicate PE management.
  • Diagnostic challenges arise when symptoms suggest multiple pathologies.

Observation:

  • A 26-year-old man with a history of PE presented with chest pain, a right inguinal mass, and right lower extremity edema.
  • Physical examination revealed a palpable 4x3 cm right inguinal mass.
  • Laboratory work-up showed normal d-dimer but prolonged prothrombin time and activated partial thromboplastin time.

Findings:

  • Pulmonary CT angiography initially diagnosed a left lower lobe segmental pulmonary embolus.
  • Vascular ultrasound and CT imaging of the lower abdomen were performed for further evaluation of the inguinal mass and edema.
  • The findings indicated a deep vein thrombosis (DVT) in the right lower extremity, presenting as an inguinal mass.

Implications:

  • This case underscores the need for comprehensive diagnostic workup in patients with pulmonary embolism presenting with atypical symptoms.
  • It highlights the potential for deep vein thrombosis to manifest with unusual signs such as a palpable inguinal mass.
  • Early and accurate diagnosis of DVT is crucial for appropriate management and prevention of complications.