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Bilateral pulmonary emboli: case report An 18-year-old girl developed bilateral pulmonary emboli while receiving ethinylestradiol/drospirenone for contraception. The girl had been receiving oral ethinylestradiol/ drospirenone [Yasmin; dosage not stated] for 3 months when she developed right lower chest and right upper quadrant abdominal pain. Her pain, which worsened on inspiration, progressed to her left lower chest and left upper quadrant. She became short of breath and presented to a clinic after her pain worsened during gymnastics practice. She reported sharp bilateral pain which was worse when breathing deeply, moving or lying down. She was moderately distressed, slightly tachypnoeic and had a BP of 110/64mm Hg. Examination revealed tenderness on palpation in both upper abdominal quadrants. She was transferred to the emergency room where the result of a Ddimer test was 2566 ng/mL. Bilateral lower lobe and lingular pulmonary emboli were evident on CT angiography. Oral contraception was withdrawn, and treatment with enoxaparin sodium and warfarin was initiated. Enoxaparin sodium was withdrawn after the girl’s internal normalised ratio reached the therapeutic range. Warfarin was maintained for 6 months; she was not allowed to practice gymnastics during this time, and she was advised to avoid oral contraceptive use permanently. She made a full recovery and was able to return to practice after treatment. Ouyang DL, et al. Bilateral pulmonary emboli in a competitive gymnast. Clinical 803048712 Journal of Sport Medicine 20: 64-5, No. 1, Jan 2010 - USA

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