{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T17:23:01Z","timestamp":1761844981815,"version":"3.44.0"},"reference-count":9,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,1,25]]},"published-print":{"date-parts":[[2019,3]]},"abstract":"<jats:p>A 62-year-old man presented to the Emergency Department with dyspnoea and central pleuritic chest pain radiating posteriorly to between the scapulae. His medical history included hypertension, osteoporosis and chronic kidney disease secondary to focal segmental glomerulosclerosis with relapsing nephrotic syndrome. Significant examination findings included a loud palpable P2 and a displaced apex beat. An ECG revealed sinus tachycardia with a right-bundle branch block and p-pulmonale. A CT pulmonary angiogram and aortogram demonstrated extensive bilateral pulmonary emboli and a descending thoracic aortic dissection. Subsequent ultrasound of the lower limbs confirmed an extensive, non-occlusive deep vein thrombosis in the right calf. Management of this patient involved therapeutic anticoagulation and tight blood pressure control, with plans for surgical repair delayed due to worsening renal impairment and subsequent supratherapeutic anticoagulation. Co-existence of an aortic dissection and PE has been rarely described and optimal management remains unclear.<\/jats:p>","DOI":"10.1136\/bcr-2018-228344","type":"journal-article","created":{"date-parts":[[2019,3,9]],"date-time":"2019-03-09T05:15:45Z","timestamp":1552108545000},"page":"e228344","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Thrombus risk versus bleeding risk: a clinical conundrum"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6649-032X","authenticated-orcid":false,"given":"Elisabeth","family":"Ng","sequence":"first","affiliation":[{"name":"Alfred Health, Melbourne, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adel","family":"Ekladious","sequence":"additional","affiliation":[{"name":"Department of General Medicine, Goulburn Valley Health, Shepparton, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luke P","family":"Wheeler","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,3,8]]},"reference":[{"key":"2025082708223464000_12.3.e228344.1","doi-asserted-by":"publisher","DOI":"10.1002\/clc.4960280113"},{"key":"2025082708223464000_12.3.e228344.2","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1002\/clc.4960180314","article-title":"Right pulmonary artery occlusion secondary to a dissecting aortic aneurysm","volume":"18","author":"Rau","year":"1995","journal-title":"Clin Cardiol"},{"key":"2025082708223464000_12.3.e228344.3","first-page":"226","article-title":"Pulmonary embolism and stanford type B aortic dissection in the same patient","volume":"3","author":"Chai","year":"2015","journal-title":"J Vasc Med Surg"},{"key":"2025082708223464000_12.3.e228344.4","article-title":"Increased risk of deep vein thrombosis and pulmonary thromboembolism in patients with aortic aneurysms: A nationwide cohort study","volume":"12","author":"Lee","year":"2017","journal-title":"PLoS One"},{"key":"2025082708223464000_12.3.e228344.5","doi-asserted-by":"crossref","DOI":"10.1155\/2014\/564734","article-title":"Update on abdominal aortic aneurysm research: from clinical to genetic studies","volume":"2014","author":"Kuivaniemi","year":"2014","journal-title":"Scientifica"},{"key":"2025082708223464000_12.3.e228344.6","first-page":"1217","article-title":"[Occlusion of the right pulmonary artery due to acute dissecting aortic aneurysm]","volume":"39","author":"Higashi","year":"1991","journal-title":"Nihon Kyobu Geka Gakkai Zasshi"},{"key":"2025082708223464000_12.3.e228344.7","first-page":"149","article-title":"Acute dissecting aneurysm of the ascending thoracic aorta causing obstruction and thrombosis of the right pulmonary artery","volume":"28","author":"Neri","year":"2001","journal-title":"Tex Heart Inst J"},{"key":"2025082708223464000_12.3.e228344.8","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000158"},{"key":"2025082708223464000_12.3.e228344.9","doi-asserted-by":"crossref","first-page":"831","DOI":"10.4103\/1119-3077.181355","article-title":"High-risk pulmonary embolism in a patient with acute dissecting aortic aneurysm","volume":"19","author":"Tudoran","year":"2016","journal-title":"Niger J Clin Pract"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2018-228344","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T15:22:44Z","timestamp":1756308164000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2018-228344"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,3]]},"references-count":9,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2019,3,8]]},"published-print":{"date-parts":[[2019,3]]}},"alternative-id":["10.1136\/bcr-2018-228344"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2018-228344","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2019,3]]}}}