A 35-year-old white woman presented to our emergency department 6 days after undergoing bilateral breast reduction and abdominoplasty complaining of left lower extremity swelling for 24 h; the surgery had lasted approximately 8 h but was otherwise uncomplicated. On the day of hospital admission, the patient noted acute swelling of the left leg, with left thigh pain and difficulty ambulating. She complained of mild dyspnea but thought it was related to the compressive abdominal binding used postoperatively. She denied chest pain, fever, and chills. She reported no prior personal or family history of thromboembolic disease. She had undergone uncomplicated bilateral tubal ligation remotely. Her medications included acetaminophen/hydrocodone, diazepam, iron supplements, norgestrel/ethinyl estradiol (Lo/Ovral; Wyeth Laboratories; Philadelphia, PA), and perioperative cephalexin. She reported smoking up to three packs of cigarettes a day, but had quit approximately 2 months prior to undergoing surgery. The findings of a physical examination were remarkable for tachycardia, mild tenderness at her abdominal incision site, and marked swelling and tenderness of the left leg. Chest radiographs showed no evidence of cardiopulmonary disease. Left lower extremity duplex compression ultrasound confirmed a diagnosis of deep venous thrombosis (DVT) with noncompressible segments of the common femoral, superficial femoral, and popliteal veins. The findings of a hypercoagulability workup, including tests for anticardiolipin antibodies and prothrombin gene mutation, were negative with the exception of heterozygosity for factor V Leiden. The patient was treated with enoxaparin and warfarin, in addition to analgesics. She did well and was discharged from the hospital while receiving therapy with oral warfarin.