A 39-year-old woman presented to the ED with sudden onset of dyspnea after developing palpitations. On further questioning, she had noted swollen legs and had been on a flight from Utah to Massachusetts 10 days prior to admission. Her past medical history included obesity, and she had started taking oral contraceptive agents 2 months prior to her presentation.
On presentation, the patient had a temperature of 36.3°C. Her BP was 129/80 mm Hg, heart rate was regular and tachycardic at 131 beats/min, respiratory rate was 32 breaths/min, and oxygen saturation on room air was 98%. The physical examination revealed an obese woman in no acute distress, with bilateral vesicular breath sounds without wheezes, crackles, or rhonchi. Cardiac auscultation revealed normal first and second heart sounds without murmurs, rubs, or gallops. Examination of the extremities revealed bilateral symmetric nonpitting edema to the mid-thigh.