Hospital: Hospital Universitari de Bellvitge.
Nº: C2019-168
Aut@r o Autores: I. Rodríguez Caamaño, M. Pérez Rubiralta, P. Naval Baudin, D. Leiva Pedraza, D. Nova Vaca, M.M. Serra Salas.
Presentación
A 30 y.o man with Friederich Ataxia and miocardial hypertrophy with septal predominance. Patient is unable to walk and stand. Denies toxic habits or drug allergies. Patient arrives at our hospital 14 hours after clinical symptoms onset, including absence of pulses and non-fixed lividities in the lower limbs and genital area. We performed aortic and lower extremities CTA. Findings are shown in the image attached. An ecocardiography is also performed. Due to the imaging findings, an emergent vascular surgery is performed.
Discusión
Friederich's ataxia is associated with a higher incidence of heart disease, mostly hypertrophic cardiomyopathy as well as anomalies in ventricular contraction. The case we present illustrates an acute occlusion of the infrarenal aorta secondary to an embolism of cardiac origin. Leriche syndrome or infrarenal aortic occlusion is more frequent in men over 60 years of age with atheromatous aorto-iliac disease, which usually has a less acute onset when developing collaterals. In our case, it was a patient without aortic pathology, and the occlusion was secondary to an embolism from an atrial thrombus, in which there was no development of collateral circulation, so it began as acute ischaemia of the lower limbs.
Conclusión
Acute aortic occlusion is a rare entity, which is associated with high rates of morbidity and mortality, so its diagnosis and early treatment is essential. CT angiography with contrast in arterial phase is very useful in the assessment of these patients with a specificity and sensitivity of 95%.
Bibliografía
- Yamamoto S, Yokomizo Y, Akai T, Chiyoda T, Goto H, and Masaki Y et al. Acute aortic occlusion in a patient with chronic paralysis due to spinal cord injury: a case report. Surg Case Rep. 2016 Dec, 2: 121. - Crawford JD, Perrone KH, Wong VW, Mitchell EL,