Susan's Place Transgender Resources

The New England Journal of Medicine



Westermark Sign in Pulmonary Embolism


Anant Subramanian Krishnan, M.D., and Tristan Barrett, M.D.

N Engl J Med 2012; 366:e16March 15, 2012

http://www.nejm.org/doi/full/10.1056/NEJMicm1107936 (http://www.nejm.org/doi/full/10.1056/NEJMicm1107936)   (Chest X-Ray at this article link)

http://en.wikipedia.org/wiki/Westermark_sign (http://en.wikipedia.org/wiki/Westermark_sign)

http://www.wikiradiography.com/page/Westermark+Sign (http://www.wikiradiography.com/page/Westermark+Sign)

A 47-year-old woman presented to the emergency department with acute shortness of breath and hypoxemia. Her medical history included sex reassignment, for which she was taking estrogen, and a deep-vein thrombosis on the left side, for which she had required treatment with warfarin. She had a family history of fatal pulmonary emboli.

Thanks for the post.
Poor girl had everything going against her with HRT + family history + personal history of DVT.
I feel the warning here is that anyone with a family history of DVT/stroke on HRT should have their clotting factors monitored religiously - unfortunately these things can happen without warning. :(

This article was posted on the Yahoo Support Group Site for North Texas GenderFriends recently. The "patient" was treated with Warfarin (Coumadin), a powerful maintenance anticoagulant medication, it also requires frequent blood level checking to maintain the level in the "therapeutic dosage" range. The first drug of choice is Enoxaparin (Lovenox), and one can not take Enoxaparin, Heparin is given Intravenously (IV) in a titrated (adjusted as needed to maintain therapeutic level) drip, followed up with Warfarin as a maintenance medication.

If one experiences the signs/symptoms of Venous ThromboEmbolism (VTE); Deep Vein Thrombosis (DVT) or Pulmonary Embolism (PE), if in the U. S., dial 9-1-1 immediately or have someone take you to the nearest hospital Emergency Room (ER), if outside the U. S., contact your local Emergency Medical Services (EMS) network or have someone take you to the nearest ER. PE is a MEDICAL EMERGENCY! It can be FATAL!. Twelve years ago I found an article posted on Yahoo concerning unconfirmed causes of death in Trans Women, although autopsies were not performed, the cause of death was listed as "Unknown". A good guess that VTE/DVT/PE was the cause! This is a good reason for NOT SELF MEDICATING HRT!

Also, if you are on HRT, check with your provider concerning taking Aspirin (ASA) as a preventive measure. This is the single most important risk to taking ESTROGEN, for both Cis & Trans Women! I have included links to several very good sites and articles on VTE;


http://www.stoptheclot.org/learn_more/blood_clot_symptoms__dvt.html (http://www.stoptheclot.org/learn_more/blood_clot_symptoms__dvt.html)

http://circ.ahajournals.org/content/119/15/e480.full (http://circ.ahajournals.org/content/119/15/e480.full)

http://www.medicinenet.com/deep_vein_thrombosis/page4.htm (http://www.medicinenet.com/deep_vein_thrombosis/page4.htm)

http://www.cdc.gov/ncbddd/dvt/facts.html (http://www.cdc.gov/ncbddd/dvt/facts.html)


SandraJane, News Staff

A current news story here is of a 23 year old professional footballer who collapsed with heart failure. Seems he has some inherited abnormality which was not picked up. Fortunately he has been saved.

I realise it probably doesn't really need to be said, but the point is, anything can happen to anyone. We can't live in a bubble, afraid of what might happen.

It's very sad for this woman. Speaking from personal experience, I'm sure she would have been as sad if she had not had transgender treatment.

SandraJane, good information.  Thanks

Yer welcomed Jamie D! :)

  Thanks SandraJane.  My Dr's assistant clips on an oxygen sensor to my finger first thing before the BP and other tests for this and the Dr. checks my breathing as well.    This cannot be stressed enough. 
  Joelene