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Giant thrombus filling the pulmonary trunk.

A 38-year-old married woman complained of left leg swelling, chest pain, and dyspnea. She had started taking oral contraceptives for treatment of uterine adenomyosis and myoma, approximately 3 weeks before admission. A high plasma D-dimer level (10.0 μg/mL) was observed. Color Doppler sonography and computed tomography (CT) confirmed deep-vein thrombosis (DVT) (Picture B) and pulmonary embolism; she was treated with inferior vena cava (IVC) filter placement and the anticoagulant low-molecularweight (LMW) heparin. Three days after anticoagulation, CT revealed a giant stick-like thrombus filling her pulmonary artery and trunk (Picture A) and compressing the IVC filter (Picture C). Therefore, the dose of LMW heparin was increased and administered in combination with warfarin. Consequently, recurrence of pulmonary embolism was avoided. These findings suggest an increased DVT risk is associated with oral contraceptives, which leads to serious complications such as pulmonary embolism. In addition, it is important to note that insufficient anticoagulation may cause serious problems, including movement of a large thrombus without dissolution.