A 38 year old previously healthy male presented to our ER complaining of a 2 day history of worsening left arm pain and mild shortness of breath. On examination a discolored left arm was noted and markedly reduced/absent pulses. The patient was afebrile and the only abnormal laboratory investigations was a D-Dimer of 1500 ng/ml. CT-angiography showed a totally occluded left axillary artery and partial occlusion of the brachial artery - likely embolic. Bilateral pulmonary embolism noted on subsequent CT scan.\nHeparin infusion was initiated and a surgical embolectomy performed successfully. The patient was admitted to the ICU for observation management. The patient recovered and was discharged after 2 weeks.
A 58 year old previously healthy male who presented to us after being diagnosed with Covid-19 pneumonia. On arrival the patient was displaying signs of severe respiratory distress with exhaustion. He was immediately intubated and transferred to the ICU. During his stay he was on high ventilatory and inotropic support. On day 11, all distal extremities showed non salvageable ischemia with no palpable distal pulses (). Urgent CT angiography revealed extensive thrombosis affecting aortic bifurcation and bilateral iliac systems. Despite aggressive anticoagulation the patient subsequently expired secondary to refractory shock. The patient was anti-coagulated for the entire duration of his hospital stay ().