SECONDARY POLYCYTHEMIA WITH CONCOMITANT PULMONARY AND AORTIC THROMBOEMBOLISM IN A CHRONIC SMOKER: A RARE CLINICAL PRESENTATION

Secondary polycythemia is a frequent consequence of chronic hypoxemia, yet its association with simultaneous arterial and venous thromboembolism is exceptionally rare. This case report describes a 65-year-old male, a chronic smoker with a 30-pack-year history, who presented with progressive abdominal distension and worsening dyspnea. Physical examination revealed severe hypoxia (SpO2 69% on room air) and central cyanosis. Laboratory analysis confirmed significant erythrocytosis with a hemoglobin of 18.7 g/dL and a packed cell volume (PCV) of 69%. While D-dimer was markedly elevated at 3827 ng/mL, lower limb Doppler excluded deep vein thrombosis (DVT).Echo showed mild pulmonary hypertension, Computed Tomography Pulmonary Angiography (CTPA) subsequently identified thrombi in both the pulmonary artery and the aorta. Extensive workup, including negative JAK2 mutation screening (V617F and Exon 12) and a reactive bone marrow study, excluded primary polycythemia vera. The findings emphasize the hypercoagulable risk inherent in severe secondary polycythemia and the importance of systemic vascular imaging in the presence of unexplained thromboembolic markers.