Austria, 14 April 2021, Muster et al, The Lancet
A 51-year-old woman attended our emergency department with a 3-day history of dyspnoea, fatigue, and cough; 11 days earlier she had the ChAdOx1 nCoV-19 vaccination. Laboratory investigations showed a severe thrombocytopenia of 37 × 109 platelets per L; 3 days earlier it had been 178 × 109 per L (normal 140–440). Serum concentrations of D-dimer (>34 mg/dL; normal <0·5) and C-reactive protein were increased (42 mg/L; normal <0·5); prothrombin time, partial thromboplastin time, fibrinogen, creatinine, electrolytes, aspartate aminotransferase, alanine aminotransferase, and high-sensitivity troponin T were within normal range. SARS-CoV-2 RT-PCR on a nasopharyngeal swab was negative. CT pulmonary angiography showed a central pulmonary embolism without right ventricular dysfunction (figure). Magnetic resonance venography showed venous thrombus formation in the left internal iliac vein—including the common iliac vein—with extension into the inferior vena cava.