Intracardiac Thrombosis and Multiple Arterial Thromboembolism with Acute Limb Ischemia: A Rare Complication of Carbon Monoxide Intoxication

AbstractCarbon monoxide (CO) poisoning is a very common reason for emergency ward admission, with symptoms varying from a simple headache and dizziness to severe neurological and cardiac impairment. We report here a rare clinical presentation of CO intoxication manifested by a severe cardiac impairment with intracardiac thrombus formation, acute limb ischemia, renal infarction, and carotid artery thrombosis. There have been initial reports of thromboembolic events in acute CO poisoning with intracardiac thrombosis being sparsely reported. Contrary to venous thromboembolism, arterial thromboembolism in CO poisoning seems to be extremely rare. To the best of our knowledge, this is the first report in recent literature of a combined intracardiac thrombosis and multiple arterial thromboembolism induced by CO poisoning.

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Successful use of hyperbaric oxygen therapy for limb salvage of acute limb ischemia as a complication of acute carbon monoxide poisoning

Undersea and Hyperbaric Medicine ◽

10.22462/04.06.2020.9 ◽

2020 ◽

pp. 235-240

Author(s):

Yoon-Seop Kim ◽

◽

Young Jin Youn ◽

Yong Sung Cha ◽

◽

...

Keyword(s):

Carbon Monoxide ◽

Limb Salvage ◽

Hyperbaric Oxygen ◽

Hyperbaric Oxygen Therapy ◽

Adjunctive Therapy ◽

Oxygen Therapy ◽

Limb Ischemia ◽

Acute Limb Ischemia ◽

Co Poisoning ◽

Peripheral Arterial Diseases

Acute limb ischemia (ALI) as a complication of acute carbon monoxide (CO) poisoning is rare. Several reports have utilized hyperbaric oxygen therapy (HBO2) as an adjunctive therapy for peripheral arterial diseases. However, no study has yet described the use of HBO2 for ALI precipitated by CO poisoning. Herein we report successful limb salvage achieved with adjunctive HBO2 and conventional therapies in a patient with CO-induced ALI. A 69-year-old man was admitted with acute CO poisoning; ALI of both lower extremities occurred on hospitalization day 3. Pre-existing risk factors for ALI other than CO were not definite. After conventional treatments including catheter-directed thrombolysis and endovascular thrombectomy, the right-side lesion remained and a left-side lesion was newly developed. In addition to prior therapies, 47 sessions of serial HBO2 were administered as adjunctive therapy, resulting in limb salvage. Acute CO poisoning can cause ALI as a rare complication. HBO2 may be utilized as an adjunctive treatment in ALI.

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COVID-19 Complicated with Arterial Thrombosis Resulting Acute Limb Ischemia: A Case Report from Bangladesh

Bangladesh Journal of Infectious Diseases ◽

10.3329/bjid.v7i00.50163 ◽

2020 ◽

pp. S50-S56

Author(s):

Md Reaz Uddin Chowdhury ◽

Kazi Shanzida Akter ◽

Sahedul Islam Bhuiyan ◽

Bimal Chandra Das ◽

Mohammad Moksedul Moula ◽

...

Keyword(s):

Arterial Thrombosis ◽

Virus Disease ◽

Rare Complication ◽

Arterial Occlusion ◽

Limb Ischemia ◽

Acute Limb Ischemia ◽

Rare Presentation ◽

Need To Evaluate ◽

Huge Impact ◽

Few Data

COVID-19(Corona virus disease 2019), which starts from Wuhan, China on December, 2019 spread rapidly to different countries of the world including Bangladesh. It affects huge impact on health care system. It’s a new disease with multisystem involvement. Physicians are experiencing new presentation of different cases and rare complication including arterial thrombosis. Few data is available regarding arterial thrombosis in SARS-CoV-2 infected patients. We are currently fighting with a 60 year old lady suffering from COVID-19 pneumonia with other co-morbidities developed severe arterial occlusion of right leg despite of taking anti platelet for long time for another cause. Patient developed irreversible right lower limb ischemia not improving with continuous infusion of unfractionated heparin followed by severe pulmonary embolism. So further study and recommendations will need to evaluate the cases and treatment in COVID-19 Patients with rare presentation. Bangladesh Journal of Infectious Diseases, October 2020;7(suppl_2):S50-S56

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Acute limb ischemia by a pulmonary vein stump thrombus after left lower lobectomy: a case report

JA Clinical Reports ◽

10.1186/s40981-020-00407-7 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Yuri Fujimoto ◽

Ryosuke Hamachi ◽

Yoshimasa Motoyama ◽

Etsuko Kanna ◽

Masako Murakami ◽

...

Keyword(s):

Pulmonary Vein ◽

Thrombus Formation ◽

Limb Ischemia ◽

Artery Occlusion ◽

Common Symptom ◽

Acute Limb Ischemia ◽

Inferior Pulmonary Vein ◽

Lower Lobectomy ◽

Enhanced Computed Tomography ◽

Pulmonary Vein Stump

Abstract Background Cases of systemic thromboembolism due to thrombus formation in the pulmonary vein stump after lobectomy have been reported recently. Cerebral infarction after left upper lobectomy is a common symptom in these cases. We encountered a rare case of acute limb ischemia caused by a thrombus formed in the left inferior pulmonary vein stump after left lower lobectomy. Case presentation A 62-year-old man underwent video-assisted left lower lobectomy under general anesthesia with epidural anesthesia. On postoperative day 2, he suddenly developed pain in the left calf. Contrast-enhanced computed tomography showed left popliteal artery occlusion and thrombus formation in the left inferior pulmonary vein stump. Anticoagulant therapy was started immediately, and emergent endovascular thrombectomy was performed. The patient recovered without complications. Conclusions Left lower lobectomy can cause thrombus formation in the pulmonary vein stump, leading to systemic thromboembolism. Early detection and treatment are the keys to minimize complications.

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Acute Thromboembolism from Trauma in a Patient with Abdominal Aortic Aneurysm

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2021.4.52137 ◽

2021 ◽

Vol 5 (3) ◽

pp. 357-359

Author(s):

Solomon Sebt ◽

Chris Kim ◽

Wirachin Hoonpongsimanont ◽

Eric Leroux

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Rare Complication ◽

Limb Ischemia ◽

Point Of Care Ultrasound ◽

Acute Limb Ischemia ◽

Thromboembolic Events ◽

Acute Thrombosis ◽

Abdominal Aortic ◽

History Of

Case Presentation: A 64-year-old man with a history of a 5.5-centimeter (cm) abdominal aortic aneurysm (AAA) presented to the emergency department (ED) complaining of severe back pain after climbing over a fence and falling a distance of eight feet. Prior to arrival, the prehospital paramedics reported that the patient did not have palpable pulses in either lower extremity. The initial physical examination in the ED was significant for absent dorsalis pedis pulses bilaterally as well as absent posterior tibialis pulses bilaterally and cold, insensate lower extremities. Point-of-care ultrasound identified an approximate 7-cm infrarenal AAA with a mural thrombus present. After receiving several computed tomography (CT) studies including CT head without contrast and CT angiography of the chest, abdomen and pelvis, the patient was diagnosed with acute thrombosis of AAA and associated thromboembolic occlusion of both his right and left distal iliac vessels causing bilateral acute limb ischemia. He immediately received unfractionated heparin and was admitted to the hospital for embolectomy and intra-arterial tissue plasminogen activator. Discussion: Acute thrombosis of AAA and subsequent thromboembolic events are a rare but significant complication that can occur in patients with a history of AAA. Thromboembolic events may occur spontaneously or in the setting of blunt abdominal trauma. Common presenting signs and symptoms include distal limb ischemia and absent femoral pulses. Timely management and recognition of this rare complication is vital as this condition can ultimately result in limb loss or death if not treated in a timely manner. Heparinization after confirmation of non-ruptured AAA as well as vascular surgery, and therapeutic and vascular interventional radiology consultations are key steps that should be taken to decrease patient morbidity and mortality.

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Transient ST Segment Elevation Caused by Intracoronary Thrombus after Acute Carbon Monoxide Poisoning

Prehospital and Disaster Medicine ◽

10.1017/s1049023x19004898 ◽

2019 ◽

Vol 34 (6) ◽

pp. 677-680

Author(s):

Ercan Akşit ◽

Özge Turgay Yildirim ◽

Fatih Aydin ◽

Okan Bardakci ◽

Ayşe Hüseyınoğlu Aydin

Keyword(s):

Carbon Monoxide ◽

Coronary Angiography ◽

Thrombus Formation ◽

Carbon Monoxide Poisoning ◽

Holter Monitoring ◽

Bare Metal Stent ◽

Co Poisoning ◽

St Segment Elevation ◽

Cardiac Symptoms ◽

St Segment

AbstractCarbon monoxide (CO) poisoning is the most common cause of death and injury among all poisonings. Myocardial injury is detected in one-third of CO poisonings. In this Case Report, a previously healthy 41-year-old man was referred for CO poisoning. The initial electrocardiogram (ECG) showed 1mm ST segment elevation in leads DII, DIII, and aVF. As the patient did not describe chest pain and had no cardiac symptoms, ECG was repeated 10 minutes later and it was seen that ST segment elevation disappeared. As the patient had a transient ST segment elevation and elevated high-sensitive Tn-T (HsTn-T), the patient was transferred to the coronary angiography laboratory. The patient’s left coronary system was normal, but a thrombus image narrowing the lumen by approximately 60% was observed in the right coronary artery. Intravenous tirofiban was administered for 48 hours. Control coronary angiography showed continuing thrombus formation and a bare metal stent was successfully implanted. This is the first reported case with transient ST segment elevation associated with acute coronary thrombus caused by CO poisoning. It may be recommended that patients with CO poisoning should be followed-up with a 12-lead ECG monitor or 24-hour ECG Holter monitoring, even if they show no cardiac symptoms and echocardiography shows no wall motion abnormality. Early coronary angiography upon detection of such dynamic ECG changes in these recordings as ST segment elevation can reduce the risk of myocardial infarction (MI) and mortality in these patients.

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Acute Limb Ischemia: A Rare Complication of COVID-19

Cureus ◽

10.7759/cureus.11488 ◽

2020 ◽

Author(s):

Sidra A Hasan ◽

Ayema Haque ◽

Fatima Nazir

Keyword(s):

Rare Complication ◽

Limb Ischemia ◽

Acute Limb Ischemia

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Thrombolytic therapy in a patient with inferolateral myocardial infarction after carbon monoxide poisoning

Human & Experimental Toxicology ◽

10.1177/0960327115577542 ◽

2015 ◽

Vol 35 (1) ◽

pp. 101-105 ◽

Cited By ~ 5

Author(s):

M Unlu ◽

C Ozturk ◽

S Demirkol ◽

S Balta ◽

A Malek ◽

...

Keyword(s):

Myocardial Infarction ◽

Carbon Monoxide ◽

Chest Pain ◽

Coronary Angiography ◽

Myocardial Injury ◽

Thrombus Formation ◽

Co Poisoning ◽

St Segment Elevation ◽

Upper Limit ◽

St Segment

Introduction: ST segment elevation myocardial infarction (STEMI) due to coronary artery occlusion caused by intracoronary thrombosis in the setting of acute carbon monoxide (CO) poisoning is a very rare presentation. We present a case of intracoronary large and mobile thrombus formation after CO poisoning. Case presentation: A previously healthy 50-year-old woman was referred for CO poisoning. She had chest pain after exposure to CO. Her initial mental status was preoccupied with chest pain. Her initial CO fraction was 28.1%, and initial laboratory data showed creatine kinase–myocardial isoenzyme of 134 U/L (upper limit 25 U/L) and troponin I of >50 ng/mL (upper limit 0.06 ng/mL). Electrocardiography was carried out on admission, revealing an ST segment elevation in the inferolateral leads. After initial evaluation, coronary angiography was performed and an intracoronary large mobile thrombus was seen in the proximal left anterior descending (LAD) artery with no significant stenosis. We administered tenecteplase with heparin. After the thrombolytic therapy, ST elevation in the inferolateral leads resolved. Repeat angiography was performed after 24 h; the thrombus in LAD had resolved. The patient was discharged after 5 days, with persistent Q wave in the inferior leads and mild hypokinesia of the inferoposterior wall suggesting myocardial injury. Conclusion: We describe intracoronary thrombus formation induced by CO poisoning. Because intracoronary thrombus can result in myocardial infarction, its consideration following CO poisoning is important. Patients with CO poisoning who have symptoms of STEMI should be carefully evaluated with serial electrocardiograms, cardiac biomarkers, and an echocardiogram. When there is evidence of acute myocardial injury, a primer in coronary angiography can determine which patients could benefit from intervention.

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Acute limb ischemia in a patient with pre-fibrotic myelofibrosis complicated by heparin-induced thrombocytopenia and thrombosis – case report and systematic review of dabigatran use

VASA ◽

10.1024/0301-1526/a000876 ◽

2020 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Marina Di Pilla ◽

Stefano Barco ◽

Clara Sacco ◽

Giovanni Barosi ◽

Corrado Lodigiani

Keyword(s):

Systematic Review ◽

Case Report ◽

Lower Limb ◽

Limb Ischemia ◽

Acute Limb Ischemia ◽

Review Of The Literature ◽

Heparin Induced Thrombocytopenia ◽

Lower Limb Ischemia ◽

Vein Thrombosis ◽

Left Lower Limb

Summary: A 49-year-old man was diagnosed with pre-fibrotic myelofibrosis after acute left lower-limb ischemia requiring amputation and portal vein thrombosis. After surgery he developed heparin-induced thrombocytopenia (HIT) with venous thromboembolism, successfully treated with argatroban followed by dabigatran. Our systematic review of the literature supports the use of dabigatran for suspected HIT.

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