Clinical Case: Massive Lower Extremity DVT Treated with Thrombolysis

20 yo CM is admitted to the hospital with RLE pain for 1 week. The pain started when he was jumping on a trampoline and he thinks that he might have twisted his ankle. Two days later he noted swelling of his right leg, which is getting progressively worse.

He was admitted to a hospital and a Duplex of RLE showed a large DVT extending from the ankle to the femoral vein in the groin area. Heparin IV was started, overlapped with Coumadin 2 days later.

What happened?
Five days later, the RLE pain is the same or worse, and the circumference of the leg increased despite the anticoagulation treatment.

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Image source: Gray's Anatomy 1918, public domain