Axillary vein thrombosis and pulmonary embolism possibly due to oral contraception

A 30-year-old woman who had been taking Norlestrin for 6 months experienced 4 episodes of chest pain diagnosed as recurrent pulmonary embolism. First she had 4 days of right chest pain then 2 weeks later was hospitalized for 10 days after 3 days of left pleuritic pain. After the pain subsided she returned to work but remained tired. 11 weeks later she was readmitted after 2 weeks of left pleuritic pain which subsided in 2 days but reappeared 1 week later on the right. At this time a lung-scan revealed an extrapulmonary focus in the right axilla and the decreased uptake in the left lower lung and scalloping of the lateral borders which were indicative of pulmonary emboli. A venogram showed partial occlusion in the right axilla. A pulmonary angiogram disclosed multiple filling defects throughout both pulmonary arteries with diminished vasculature in the left midlung. The oral contraceptive was discontinued and dicoumarin anticoagulant therapy was instituted. The patient was discharged in 23 days felt well in 10 weeks and lung scan and pulmonary engiogram were almost normal in 4 months.