Concomitant Deep Venous Thrombosis, Femoral Artery Thrombosi
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The association between air travel and deep venous thrombosis/pulmonary embolism was first reported in 1954. Soon after, the phrase “economy-class syndrome” was used to describe this problem, with several more published case series appearing in the literature. The mechanism behind the increased risk for clotting complications was proposed to include blood stasis, along with one or more of the following: lower extremity fluid retention, hemoconcentration of clotting factors, and possible activation of the coagulation cascade. A few authors have also related this condition to long duration travel by car and train. This syndrome, however, does not describe an association between long duration travel and arterial thrombosis or the coexistence of venous and arterial thrombosis simultaneously. We report a case of concomitant deep venous thrombosis and acute femoral artery thrombosis along with bilateral pulmonary embolism after a long overseas flight.

Case Report
A 50-year-old woman from Montenegro presented to our institution with shortness of breath that was associated with pleuritic chest pain. Her symptoms began during a long overseas flight and progressively worsened after disembarking the plane.
She also complained of left leg pain and swelling. The patient's past medical history was significant for hypertension and diabetes mellitus. She never smoked and was not on any hormonal treatments. On physical exam, heart rate was 115, respiratory rate was 32, and she appeared to be in mild distress. Bilateral breath sounds were clear to auscultation. Of note, the patient had swelling of the left lower extremity and foot with some dark discoloration, absence of distal pulses, and impaired sensation. Initial laboratory tests revealed respiratory alkalosis, a normal coagulation profile, and a D-dimer of 1300?ug/L. Cardiac enzymes were within normal limits. EKG showed sinus tachycardia. A CT scan of the chest revealed bilateral pulmonary embolisms......