670138.fig.001a
(a)
670138.fig.001b
(b)
670138.fig.001c
(c)
670138.fig.001d
(d)
Figure 1: A 27-year-old woman, without any vascular risk factors, presented with mild right-sided weakness of suddenonset. She was noted to have swelling and pain in the right leg. Duplex sonography revealed extensive deep vein thrombosis involving the popliteal as well as superficial femoral vein, as characteristic noncompressibility and echogenic mass in the venous lumen. (a) Computerized tomographic angiography of thorax revealed filling defect in the left pulmonary artery. (b) Transcranial Doppler ultrasonographic monitoring of left middle cerebral artery during the “bubble test” (injection of agitated 9 mL normal saline and 1 mL air) revealed numerous microembolic signals, (c) suggestive of a right-to-left shunt (patent foramen ovale). Multiple acute ischemic infarcts involving many arterial territories were evident on the diffusion-weighted magnetic resonance imaging of the brain. (d) Blood tests were positive for lupus anticoagulant and anticardiolipin antibodies.