A 16-year-old girl arrived intubated to the emergency department. She had shortness of breath and cough for 2 days with leg pain. On arrival, she was hemodynamically stable with an unremarkable physical exam. Electrocardiogram revealed a prolonged QT interval; laboratory work-up was normal except for an elevated dimerized plasmin fragment D. Acute pulmonary embolism was confirmed by a chest computed tomography scan. A lower extremity duplex scan was negative and echocardiogram revealed a patent foramen ovale with bidirectional shunting. An inferior vena cava filter was placed to prevent acute recurrence and unfractionated heparin was initiated. The next day she was noted to have right hemiparesis. Stroke was confirmed by magnetic resonance imaging. The patient underwent mechanical clot retrieval and was discharged on anticoagulation therapy to a brain rehabilitation unit.
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