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Recurrent systemic embolism caused by descending thoracic aortic mural thrombus in a young cannabis abuser.

ABSTRACT: Aortic mural thrombi are a rare cause of peripheral arterial embolic events. We report the case of a young man with prior history of Buerger's disease and marijuana abuse. He presented visceral infarctions due to descending thoracic aortic mobile pedunculated thrombus with complex atherosclerosis. Cannabis was stopped, intravenous heparin and vitamin K antagonist (VKA) therapies were administered. At 3-month follow-up, he was free of thromboembolic events and aortic imaging normalized. Optimal treatment of embolized aortic thrombus remains controversial, but systemic anticoagulation is widely accepted as the first-line therapy. .

SUBMITTER: Noel A

PROVIDER: S-EPMC6280688 | biostudies-literature | 2016 Mar

REPOSITORIES: biostudies-literature

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Recurrent systemic embolism caused by descending thoracic aortic mural thrombus in a young cannabis abuser.

Noel Antoine A Le Ven Florent F Gilard Martine M Bressollette Luc L Castellant Philippe P Vinsonneau Ulric U Paleiron Nicolas N Mansourati Jacques J

Journal of cardiology cases 20151210 3

Aortic mural thrombi are a rare cause of peripheral arterial embolic events. We report the case of a young man with prior history of Buerger's disease and marijuana abuse. He presented visceral infarctions due to descending thoracic aortic mobile pedunculated thrombus with complex atherosclerosis. Cannabis was stopped, intravenous heparin and vitamin K antagonist (VKA) therapies were administered. At 3-month follow-up, he was free of thromboembolic events and aortic imaging normalized. Optimal t ...[more]

PMID: 30546616

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Project description:Background Penetrating ulcers of aorta, aortic dissections and intramural hematomas all come under acute aortic syndromes and have important similarities and differences. Case report We report a 67?year old man with rupture of a large penetrating ulcer of the distal ascending aorta with hemopericardium and left hemothorax. He underwent interposition graft replacement of ascending aorta and hemi-arch with a 30?mm Gelweave Vascutek graft but represented 6?months later with development of a penetrating ulcer which ruptured into a huge 14?cm pseudoaneurysm. This was repaired with a 28?mm Vascutek Gelseal graft replacement of arch and interposition graft reconstruction of innominate and left common carotid arteries. 6?weeks later, however, he ruptured his proximal descending aorta and underwent TEVAR satisfactorily. Unfortunately, 2?days later, he developed a pathological fracture of left proximal tibia with metastasis from a primary renal cell carcinoma. He died 3?weeks later from respiratory failure. We shall briefly outline the similarities and differences in presentation and management of penetrating aortic ulcers, aortic dissections and intramural haematomas. We shall discuss, in greater detail, penetrating ulcers of thoracic aorta, their natural history, location, complications and management. Conclusion This case report is unique on account of initial successful surgical redressal following rupture of penetrating ulcer of distal ascending aorta into left pleural and pericardial cavities, normally associated with instant death. The haemodynamic effects of the rupture were staggered due to initial contained rupture into a smaller pseudoaneurysm, followed by a further rupture into a false aneurysmal sac followed eventually by generalised rupture into the pleural and pericardial cavities - a unique way of aortic rupture. Further development of another penetrating ulcer and a small pseudoaneurysm in the distal arch 6?months later which further ruptured into a larger 14?cm false aneurysmal sac, which again did not result in exsanguination, is again extraordinarily rare. Thereafter he underwent emergency thoracic endovascular aortic repair (TEVAR) for a further rupture of descending thoracic aorta. All three ruptures were managed successfully and would usually be associated with near-certain death, only for the patient to succumb eventually to the complications of metastatic renal cell carcinoma.

Dataset Information

Recurrent systemic embolism caused by descending thoracic aortic mural thrombus in a young cannabis abuser.

Publications

Recurrent systemic embolism caused by descending thoracic aortic mural thrombus in a young cannabis abuser.

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