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Deep Venous Thrombosis (DVT) develops in chronic diseases and prolonged immobilization. DVT is usually complicated by pulmonary embolism (PE). Common presentation of pulmonary embolism is chest pain and dyspnea. Similar is the presentation in patients with acute coronary syndrome (ACS). However, a patient who present with ACS and acute limb Ischemia and later on develop DVT complicated by PE simultaneously, is a very rare phenomenon. Such coexistence developed by chance or a common pathophysiological process, remains unclear. Again, it is very difficult to ascertain, what was the initial event and what was the sequence of events. Management of such patients is also challenging, as priority of treatment has to be decided. ACS and acute limb ischemia, if not intervened well on time, usually end up in acute myocardial infarction or death and gangrenous limb or amputation, respectively. We received a patient in emergency room with ACS, acute limb ischemia, DVT and PE. This case report was a diagnostic and management dilemma. Such a coincidence is very unusual and therefore this case is presented.
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