Hospital: Hospital universitario de Getafe.
Aut@r o Autores: I. Cedrun, A. Berral, G. Diaz, E. Escudero, A. Jimenez.
A 48-year-old man presented to the Emergency Department for acute lumbar pain and lower extremities paraesthesia and pallor.The patient had a history of seminomatous tumor in remission. Clinical examination demonstrates tachypnea, pallor and pulselessness of both inferior limbs. CT with intravenous contrast material shown filling defects within both principal pulmonary arteries compatible with acute pulmonary emboli with loculated pleural effusion associated, and an abrupt occlusion of the infrarrenal aorta and iliac arteries. An echocardiogram was done, revealing depressed systolic function of left ventricle. The right ventricle was dilated and hypocontractile. And the passage of microbubbles through patent foramen ovale was shown. Vascular surgery consult was requested and emergent thrombectomy was performed. Three days later the patient presented nonreactive anisocoria. A brain CT scan was done, showing large infarct of the left medial cerebral artery. Finally, the patient passed away two days later.
Acute aortic occlusion is a rare phenomenon. It requires prompt diagnosis and emergent intervention on account of high mortality rate. The clinical presentation is sudden and characterized by lower extremity pain, paralysis, and marbled extremities. (1) Pulmonary embolism is a much more frequent entity. It is caused by the migration of deep venous thrombi from the lower extremities veins to the pulmonary vasculature. Coexistence of embolisms both in the pulmonary circulation and in the systemic circulation should make us think about the possibility of a paradoxical embolism, which suggests a diagnosis of an intracardiac defect. The most common intracardiac defect associated with paradoxical embolism is patent foramen ovale (PFO), which has been described in 25%–30% of individuals . The triad of systemic embolism, venous thrombosis, and intracardiac communication defines the clinical diagnosis of PDE. The diagnosis of PDE is termed “possible” if an arterial embolism and an intracardiac communication that could allow a right to left shunt, are detected.(2).
In the presence of systemic embolisms without a clear cardiac or embolic cause, it is necessary to consider, given the high prevalence of deep vein thrombosis, the possibility of a paradoxical embolism. The diagnosis is considered possible when all the three criteria are met. Only when the thrombus is directly visualized crossing an intracardiac defect in the setting of an arterial embolus the diagnosis is considered definitive.
- Deser SB, Demirag MK. Acute thrombotic occlusion of infrarenal abdominal aorta: A case report. Cardiovasc Disord Med 2016, 1 (1):14-15. - Saremi F, Emmanuel, Wu PF, Ihde L, Shavelle D, Go JL et al. Paradoxical Embolism: Role of Imaging in Diagnosis and