A 40-year-old African American man with a history of sickle cell disease (SCD), deep venous thrombosis and alcohol abuse was transferred to the medical intensive care unit for worsening agitation and stridor. Physical examination revealed a symmetrically swollen neck with large palpable veins over the anterior chest wall and abdomen. Figure 1 is an axial computed tomographic image of his chest which illustrates several large superficial collateral veins (arrows). A volume rendered computed tomographic image in Figure 2 depicts the extent of his chest and abdominal wall varicosities (arrows). The presence of extensive venous collateralization suggested that the thrombosis had been present for a prolonged period of time. Although SCD is a hypercoagulable state, a compelling causal link with venous thromboembolism is not well established. However, a higher prevalence of pulmonary embolism and to a lesser extent deep venous thrombosis has been observed in African Americans with SCD. A negative laboratory evaluation for a second hypercoagulable state suggested that SCD was the cause for the thrombosis. The patient was eventually discharged on subcutaneous enoxa-parin twice daily.
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