Arq Bras Cardiol: Imagem cardiovasc. 2022; 35(3): eabc270
Symptomatic Aortic Mural Thrombus in a Patient With COVID-19
DOI: 10.47593/2675-312X/20223503eabc270
A 56-year-old male former smoker with a history of diabetes mellitus developed flu-like symptoms (cough, fever, and myalgia) that worsened after nine days (dyspnea and asthenia) sought medical attention in an emergency care unit. He was hospitalized with novel coronavirus (sudden acute respiratory syndrome coronavirus 2) infection confirmed by polymerase chain reaction testing. His condition progressed with sudden pain in the left lower limb, toe coldness and paresthesia without motor changes, and pain in the third finger of the left hand associated with non-fixed cyanosis. The patient was referred to the emergency room of Hospital das Clínicas of Ribeirão Preto with acute arterial occlusion. On evaluation, he presented non-fixed cyanosis in the distal phalanx of the third finger of the left hand with no pulse or neurological changes throughout the limb. The left lower limb presented no pulse of or arterial flow in the anterior and posterior tibial arteries. He underwent urgent thrombectomy (Rutherford class 2A) with thrombus removal, and limb perfusion was restored with pulsatile tibial artery flow. The patient remained on anticoagulant therapy with unfractionated heparin. Computed tomography angioplasty used to analyze the embolism demonstrated mural thrombi at the origin of the left subclavian artery and in the infrarenal aorta (, ). The patient progressed with good arterial condition (resolution of left upper limb non-fixed cyanosis and presence of pulse in the left leg), stayed in the intensive care unit for three days, and was discharged after two days of anticoagulant treatment (rivaroxaban [Xarelto®]). In outpatient follow-up, he remained asymptomatic and presented no new embolic events, and the mural thrombi resolved completely after one year of anticoagulant therapy (, ).
[…]
Keywords: Thrombosis
247
