Imaging: Student/Resident Case Report Poster - Imaging |

Aortic Thrombi: Unusual Cause of Critical Limb Ischemia FREE TO VIEW

Tulani Washington-Plaskett, MD; Pradyumna Agasthi, MD; Aneese Chaudhry, MD; Rajesh Sachdeva, MD
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Morehouse School of Medicine, Atlanta, GA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):669A. doi:10.1016/j.chest.2016.08.763
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SESSION TITLE: Student/Resident Case Report Poster - Imaging

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Aortic mural thrombus is a frequent manifestation of underlying subclinical atherosclerosis. We describe and unusual case of critical limb ischemia caused by mural thrombi within the aorta.

CASE PRESENTATION: A 60-year-old male with a medical history of hypertension and tobacco abuse presented to emergency department with a complaint of epigastric abdominal pain of 2 hours duration that radiated up to the left side of his chest. The patient had no history of pulmonary embolism or deep vein thrombosis. Initial electrocardiogram (EKG) revealed normal sinus rhythm with left ventricular hypertrophy. Troponin was negative. The patient decided to leave against medical advice however returned shortly after with cramping and severe right lower extremity pain. Physical exam was remarkable for non-palpable dorsalis pedis and posterior tibialis pulse with no Doppler signal. Computed Tomography (CT) dissection protocol revealed three small floating thrombi attached to lateral wall of the aorta within the aortic arch. CT angiogram of the right lower extremity revealed complete occlusion of the popliteal artery immediately proximal to the trifurcation at about the level of the knee. Limited hyper-coagulable work up was negative. The patient received catheter-directed thrombolytic therapy of his right popliteal artery and was started on systemic anticoagulation. In 6 months, on repeat CT dissection protocol, the aortic thrombi previously seen were no longer present.

DISCUSSION: Aortic mural thrombus may be the consequence of a more generalized hyper-coagulation or vascular endothelial disorder.

CONCLUSIONS: Non-aneurysmal thoracic aortic mural thrombus is a very rare cause of critical limb ischemia. Our report emphasizes the importance of non-invasive evaluation of the heart and aorta in management of peripheral arterial thromboembolism.

Reference #1: Maloberti A, Oliva F, Chiara B, Giannattasio C. Asymptomatc aortic mural thrombus in a minimally atherosclerotic vessel. Interact CardioVasc Thorac Surg. (2016); 22 (3): 371-373.

DISCLOSURE: The following authors have nothing to disclose: Tulani Washington-Plaskett, Pradyumna Agasthi, Aneese Chaudhry, Rajesh Sachdeva

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