Isquemia aguda por trombosis aórtica en COVID-19: A propósito de un caso

Objetivo: Presentar un caso de isquemia aguda por trombosis aórtica en paciente con infección por COVID-19 y exponer la importancia del diagnóstico y manejo oportuno. Introducción: El coronavirus (COVID-19) afecta principalmente al tracto respiratorio, pero presenta predisposición a fenómenos trombóticos y sus complicaciones, siendo una de las más graves la isquemia aguda por trombosis aórtica. Caso clínico: Paciente masculino de 68 años, que cursa con cuadro clínico de neumonía grave por COVID-19, presenta de forma concomitante episodio de trombosis aórtica aguda, resultando con isquemia aguda de extremidades inferiores. Se realizó trombectomía, post procedimiento y asociado a reperfusión, presentó paro cardiorrespiratorio con asistolia sostenida, falleciendo pese a maniobras de reanimación. Conclusión: Pese a las medidas de profilaxis con heparina de bajo peso molecular (HBPM), se deben sospechar y buscar las complicaciones tromboembólicas en pacientes que cursan con esta infección para dar un manejo oportuno y vigilar las complicaciones post quirúrgicas que pueden ser mortales.

Aim: To present a case of acute ischemia due to aortic thrombosis in a patient with COVID-19 infection and explain the importance of diagnosis and timely management. Introduction: The coronavirus (COVID-19) mainly affects the respiratory tract, but it has a predisposition to thrombotic phenomena and its complications, one of the most serious being acute ischemia due to aortic thrombosis. Clinical case: 68-year-old man, coronary heart disease with severe pneumonia due to COVID-19, presents aortic thrombosis, resulting in acute lower extremity ischemia. Thrombectomy was performed, post procedure and associated with reperfusion, presented cardiorespiratory arrest with sustained asystole, died despite resuscitation maneuvers. Conclusion: Despite prophylaxis measures with low molecular-weight heparins (LMWH), thromboembolic complications should be sought in patients with this infection to provide timely management and monitor post-surgical complications that can be fatal.

A Case of Asymptomatic Thrombus in the Ascending Aorta / 日本心臓血管外科学会雑誌

A 70-year-old man receiving neoadjuvant chemotherapy (5FU+CDDP) for esophageal cancer was transferred to our hospital for the treatment of asymptomatic thrombus in the ascending aorta. Enhanced computed tomography revealed a low-density mass of 34×16 mm in diameter on the posterior surface of the ascending aorta. We performed thrombectomy and suture plication of the aortic intima under hypothermic circulatory arrest. Intraoperative epiaortic echo showed the mass was floating in the aorta. The patient was discharged from the hospital on the 18th postoperative day. Most patients with aortic thrombus are diagnosed under conditions of peripheral embolism. Asymptomatic thrombus in the ascending aorta is extremely rare. We herein report a case of thrombectomy for asymptomatic thrombus in the ascending aorta.

Huge thrombus in ascending aorta: A case report and literature review / 吉林大学学报(医学版)

Objective: To explore the clinical diagnosis and treatment of huge thrombus in ascending aorta, and to clarify its treatment methods. Methods: The clinical materials of one patient with ascending aortic thrombus were retrospectively analyzed and the diagnosis and treatment were summerized, and the relevent literatures were reviewed. Results: The patient was male, and admitted to hospital due to space-occupying lesion in the ascending aorta in routine examination. The results of aortic CTA reported that there was a 22 mm×22 mm×45 mm spaceoccupying lesion in the ascending aorta. The patient was successfully treated with thrombectomy and ascending aorta replacement in order to prevent the systemic embolization. The histopathological examination revealed that the lesion was thrombus. Conclusion: Aortic CTA is a useful examination for the patients with thrombus in ascending aorta. Resection of thrombus and implantation of vascular graft can reduce the risk of recurrent stroke effectively.

A Case of Huge Thrombus in the Aortic Arch with Cerebrovascular Embolization

Pedunculated thrombus in the aortic arch that is associated with cerebral infarction is very rare requires prompt diagnosis and treatment to prevent occurrence of another devastating complication. Transesophageal echocardiography is useful for detecting source of embolism including aortic thrombi. The treatment options of aortic thrombi involves anticoagulation, thrombolysis, thromboaspiration, and thrombectomy. Here we report a case of huge thrombus in the aortic arch, resulting in acute multifocal cerebellar embolic infarct in patient without any risk factors for vascular thrombosis. Thrombi in the aortic arch were diagnosed by transesophageal echocardiography and treated with anticoagulants successfully.

A Case of Aortic Arch Thrombus Associated with Acute Pyelonephritis in a Patient with Thrombocythemia / 대한신장학회잡지

Aortic thrombus is a rare but life threatening disorder. The usual causes of aortic thrombus are primary or secondary thrombocythemia, malignancy, atherosclerosis, trauma, and acute infectious disease. Here, we report a case of aortic arch thrombus associated with acute pyelonephritis in a patient with thrombocythemia. A 78-year-old woman was admitted with acute pyelonephritis. A complete blood cell count showed severe thrombocythemia with platelet count of 1, 340, 000/mm3. Chest CT scan demonstrated floating thrombus in the aortic arch. After antibiotic treatement, platelet count decreased to 770, 000/mm3 and aortic thrombus disappeared without thrombolytic therapy.

Urokinase Treatment for Aortic Thrombus in Preterm Infants

PURPOSE: Aortic thrombus is a rare but serious complication in neonates, usually associated with central vessel catheterization. Currently treatment of asymptomatic aortic thrombus in preterm infants is controversial. We evaluated effects of urokinase in preterm infants with aortic thrombi. METHODS: We studied 12 preterm infants in whom umbilical arterial catheterizations were performed and subsequently aortic thrombi were detected. In six patients bolus doses of urokinase 4, 400 IU/kg were injected, followed by continuous infusions of 4, 400 IU/kg/hr. The mean duration of urokinase use was 11 days (6-13 days). The other six patients who did not receive urokinase served as controls. The two groups were compared for changes in the size of thrombi. RESULTS: The initial sizes of aortic thrombi upon detection were similar, although the diagnoses were made earlier in urokinase group than in controls. The days to 50% reduction in size of thrombi were significantly shorter in urokinase group, as were the days to complete resolution. One infant in urokinase group and 2 infants in control group had persistent aortic thrombi up to 90 days of follow-up. Intracranial hemorrhage and disseminated intravascular coagulopathy were absent in all 12 cases. CONCLUSION: Urokinase administration could be an effective therapy for preterm neonates with aortic thrombi. It significantly reduces the size of the thrombus and shortens the days to complete resolution.

Cerebral Infarction Caused by Floating Thoracic aortic Thrombus in Young Male

A case of embolic episode resulting in cerebral infarction from an unknown source is reported. This occured in a young male. He had no cardiovascular risk factors. Diagnostic evaluation for identifying the source of embolism revealed a large, pedunculated and mobile thrombus arising from a nonaneurysmatic and nonatheroslerotic descending aorta. The thrombus was identified by transesophageal echocardiography, and was successfully removed by aortic thromboendarterectomy. We emphasize the importnace of transesophageal echocardiography as a reliable method for the diagnosis of thoracic aorta diseases and for identification of aortic thrombi. An aggressive surgical approach is recommended in the low-risk parient to prevent further embolic episodes.