Quite a backup: pericardial varices in a patient with hereditary antithrombin deficiency

A 39 year-old female with known hypertension, gastro-esophageal reflux disease, and hereditary anti-thrombin deficiency (hATD) on life-long anti-coagulation presented to our emergency room with acute atypical chest and epigastric pain. Her hATD was diagnosed five years prior when repeated deep vein thromboses were discovered. At that time, the patient was started on life-long anticoagulation with warfarin and was able to consistently achieve therapeutic levels.