A case report of multisite arterial thrombosis in a patient with coronavirus disease 2019 (COVID-19)

Abstract Background A systemic coagulation dysfunction has been associated with COVID-19. In this case report, we describe a COVID-19-positive patient with multisite arterial thrombosis, presenting with acute limb ischaemia and concomitant ST-elevation myocardial infarction and oligo-symptomatic lung disease. Case summary An 83-year-old lady with history of hypertension and chronic kidney disease presented to the Emergency Department with acute-onset left leg pain, pulselessness, and partial loss of motor function. Acute limb ischaemia was diagnosed. At the same time, a routine ECG showed ST-segment elevation, diagnostic for inferior myocardial infarction. On admission, a nasopharyngeal swab was performed to assess the presence of SARS-CoV-2, as per hospital protocol during the current COVID-19 pandemic. A total-body CT angiography was performed to investigate the cause of acute limb ischaemia and to rule out aortic dissection; the examination showed a total occlusion of the left common iliac artery and a non-obstructive thrombosis of a subsegmental pulmonary artery branch in the right basal lobe. Lung CT scan confirmed a typical pattern of interstitial COVID-19 pneumonia. Coronary angiography showed a thrombotic occlusion of the proximal segment of the right coronary artery. Percutaneous coronary intervention was performed, with manual thrombectomy, followed by deployment of two stents. The patient was subsequently transferred to the operating room, where a Fogarty thrombectomy was performed. The patient was then admitted to the COVID area of our hospital. Seven hours later, the swab returned positive for COVID-19. Discussion COVID-19 can have an atypical presentation with thrombosis at multiple sites.

Download Full-text

Delayed manifestation of COVID-19 presenting as lower extremity multilevel arterial thrombosis: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa371 ◽

2020 ◽

Author(s):

Cecilia Schweblin ◽

Anne Lise Hachulla ◽

Marco Roffi ◽

Frédéric Glauser

Keyword(s):

Computed Tomography ◽

Arterial Thrombosis ◽

Thrombotic Event ◽

Common Femoral Artery ◽

Nasopharyngeal Swab ◽

Limb Ischaemia ◽

Antibody Testing ◽

Internal Iliac ◽

Computed Tomography Angiogram ◽

The Right

Abstract Background Venous thrombo-embolic events have been described in hospitalized patients with coronavirus disease 2019 (COVID-19), suggesting the presence of coagulopathy induced by the viral infection. To date, only rare cases of arterial thrombosis related to COVID-19 have been reported. Case summary A 54-year-old patient with an influenza-like illness 15 days earlier, which resolved, and no known cardiovascular risk factor presented with acute right lower limb ischaemia. A computed tomography angiogram of the abdominal aorta and lower extremities showed, in the absence of vascular disease, a subocclusive thrombosis of the right common iliac artery and an occlusion of the right internal iliac, profunda femoral, and popliteal arteries. On the left side, the computed tomography angiogram demonstrated a non-occlusive thrombosis of the common femoral artery. The patient underwent emergency surgical thrombectomy as well as endovascular revascularization on the right side followed by therapeutic anticoagulation, with normalization of the limb perfusion. A nasopharyngeal swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by real-time reverse transcription–PCR (rRT–PCR) was negative three times. Haemostasis analysis showed a mild hyperfibrinogenaemia and a shortening of the activated partial thromboplastin time. An extensive screening for cardio-embolism was negative. As the thrombotic event was unexplained, antibody testing for SARS-CoV-2 was performed and the result was positive. Discussion Venous thrombosis and pulmonary embolisms have been observed in COVID-19. As in our case, the first reports on COVID-19-associated arterial thrombotic events have emerged. A better understanding of the coagulopathy in COVID-19 is essential to guide prevention and treatment of venous as well as arterial thrombo-embolic events.

Download Full-text

Acute Limb Ischaemia Following Elective Left Upper Lobectomy for Early NSCLC: A Rare but Serious Complication Arising from the Pulmonary Vein Stump

10.31487/j.crss.2020.01.02 ◽

2020 ◽

pp. 1-2

Author(s):

James Elliott ◽

Anand Iyer ◽

James Elliott

Keyword(s):

Pulmonary Vein ◽

Ct Angiography ◽

Mediastinal Lymph Node ◽

Case Reports ◽

Common Femoral Artery ◽

Sudden Onset ◽

Leg Pain ◽

Limb Ischaemia ◽

Left Upper Lobectomy ◽

Acute Limb Ischaemia

Patients undergoing Left Upper Lobectomy (LUL) appear to be at risk of a unique post-operative complication that is not well-documented: Pulmonary Vein (PV) stump thrombosis +/- systemic arterial embolisation [1-3]. We describe the details of a rare case from our institution, present a review of this subject from the limited literature available, and suggest potential strategies to anticipate, detect and manage this entity. A 70 year old female patient underwent left upper lobectomy and mediastinal lymph node sampling via repeat left thoracotomy. The procedure was unremarkable apart from some adhesions. She progressed well post-operatively on the ward. On post-operative day 2 the patient developed sudden-onset left leg pain and paraesthesia and CT-Angiography confirmed the diagnosis of left common femoral artery embolus and left superior PV stump thrombosis. The patient returned to theatre for femoral embolectomy, continued systemic anticoagulation, and made an excellent recovery thereafter. The aetiology of this complication has been documented in some case reports, but it is not explored further in trials or thoracic surgery texts [2-3]. One cohort study involving CT-angiography after lobectomy surgeries found that left upper lobectomy was unique as a risk factor for PV stump thrombosis1. It may be related to the relatively longer LSPV stump and stasis of blood in the stump [4].

Download Full-text

Acute myocardial infarction caused by embolism of thrombus in the right coronary sinus of valsalva: a case report and review of the literature

Journal of the American Society of Echocardiography ◽

10.1016/j.echo.2003.10.002 ◽

2004 ◽

Vol 17 (2) ◽

pp. 173-177 ◽

Cited By ~ 21

Author(s):

Kosei Eguchi ◽

Eiji Ohtaki ◽

Kazuhiko Misu ◽

Masaru Aikawa ◽

Tetsuya Sumiyoshi ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Case Report ◽

Coronary Sinus ◽

Sinus Of Valsalva ◽

Review Of The Literature ◽

The Right

Download Full-text

Antiphospholipid Syndrome - A Case Report of Pulmonary Thromboembolism, Followed with Acute Myocardial Infarction in Patient with Systemic Sclerosis

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2015.114 ◽

2015 ◽

Vol 3 (4) ◽

pp. 705-709 ◽

Cited By ~ 2

Author(s):

Marija Vavlukis ◽

Irina Kotlar ◽

Emilija Chaparoska ◽

Bekim Pocesta ◽

Hristo Pejkov ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Pulmonary Embolism ◽

Systemic Sclerosis ◽

Antiphospholipid Syndrome ◽

Total Occlusion ◽

St Segment Elevation ◽

St Segment ◽

History Of ◽

The Right

AIM: We are presenting an uncommon case of pulmonary embolism, followed with an acute myocardial infarction, in a patient with progressive systemic sclerosis.CASE PRESENTATION: A female 40 years of age was admitted with signs of pulmonary embolism, confirmed with CT scan, which also reviled a thrombus in the right ventricle. The patient had medical history of systemic sclerosis since the age of 16 years. She suffered an ischemic stroke 6 years ago, but she was not taking any anticoagulant or antithrombotic medications ever since. She received a treatment with thrombolytic therapy, and subsequent UFH, but, on the second day after receiving fibrinolysis, she felt chest pain accompanied with ECG changes consistent for ST-segment elevation myocardial infarction (STEMI). Urgent coronary angiography was undertaken, which reviled cloths causing total occlusion in 4 blood vessels, followed with thromboaspiration, but without successful reperfusion. Several hours later the patient developed rapid deterioration with letal ending. During the very short hospital course, blood sampling reviled presence of antiphospholipid antibodies.CONCLUSION: The acquired antiphospholipid syndrome is common condition in patients with systemic autoimmune diseases, but relatively rare in patients with systemic sclerosis. Never the less, we have to be aware of it when treating the patients with systemic sclerosis.

Download Full-text

Delayed Presentation of Gluteal Compartment Syndrome: The Argument for Fasciotomy

Case Reports in Orthopedics ◽

10.1155/2016/9127070 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

John E. Lawrence ◽

Duncan J. Cundall-Curry ◽

Kuldeep K. Stohr

Keyword(s):

Compartment Syndrome ◽

Kidney Injury ◽

Limb Ischaemia ◽

Delayed Presentation ◽

Neurological Improvement ◽

Tertiary Centre ◽

Acute Limb Ischaemia ◽

Nerve Recovery ◽

The Right ◽

Gluteal Compartment Syndrome

A male patient in his fifties presented to his local hospital with numbness and weakness of the right leg which left him unable to mobilise. He reported injecting heroin the previous morning. Following an initial diagnosis of acute limb ischaemia the patient was transferred to a tertiary centre where Computed Tomography Angiography was reported as normal. Detailed neurological examination revealed weakness in hip flexion and extension (1/5 on the Medical Research Council scale) with complete paralysis of muscle groups distal to this. Sensation to pinprick and light touch was globally reduced. Blood tests revealed acute kidney injury with raised creatinine kinase and the patient was treated for rhabdomyolysis. Orthopaedic referral was made the following day and a diagnosis of gluteal compartment syndrome (GCS) was made. Emergency fasciotomy was performed 56 hours after the onset of symptoms. There was immediate neurological improvement following decompression and the patient was rehabilitated with complete nerve recovery and function at eight-week follow-up. This is the first documented case of full functional recovery following a delayed presentation of GCS with sciatic nerve palsy. We discuss the arguments for and against fasciotomy in cases of compartment syndrome with significant delay in presentation or diagnosis.

Download Full-text

Spontaneous Coronary Artery Dissection – A Case Report

University Heart Journal ◽

10.3329/uhj.v12i2.36394 ◽

2018 ◽

Vol 12 (2) ◽

pp. 105-107

Author(s):

Samsun Nahar ◽

Fatema Begum ◽

Momenuzzaman ◽

KN Khan

Keyword(s):

Myocardial Infarction ◽

Case Report ◽

Chest Pain ◽

Coronary Artery ◽

Artery Dissection ◽

Spontaneous Coronary Artery Dissection ◽

Coronary Artery Dissection ◽

St Elevation ◽

The Right ◽

Spontaneous Dissection

Spontaneous coronary artery dissection is a rather rare cause of myocardial infarction, chest pain, and sudden death.There are currently no known direct causes of this condition.Most of the reported dissections have occurred in the left anterior descending coronary artery.Herein, we report the case of a 58-year-old woman who presented at our institution with an acute ST-elevation myocardial infarction secondary to a spontaneous dissection of the right coronary artery. Primary PCIresolved the occlusion of the artery, and the patient was discharged from the hospital on medical therapy.University Heart Journal Vol. 12, No. 2, July 2016; 105-107

Download Full-text

Ring-stripping retrograde common carotid endarterectomy: case report

Sao Paulo Medical Journal ◽

10.1590/s1516-31802002000500007 ◽

2002 ◽

Vol 120 (5) ◽

pp. 154-157 ◽

Cited By ~ 11

Author(s):

Eduardo Toledo de Aguiar ◽

Alex Lederman ◽

Patrícia Matsunaga

Keyword(s):

Case Report ◽

Carotid Endarterectomy ◽

Artery Bypass ◽

Tertiary Care ◽

Retrospective Case ◽

Total Occlusion ◽

Cervical Incision ◽

The Common ◽

The Right

CONTEXT: Total occlusion of the common carotid is rare and the indications and techniques for surgical treatment are still a matter of controversy. OBJECTIVE: To demonstrate the feasibility of retrograde common carotid endarterectomy. DESIGN: Retrospective case report study. SETTING: Tertiary care private hospital. PARTICIPANTS: Three patients underwent ring-stripping retrograde common carotid endarterectomy. Their ages were 81, 68 and 65 years. All were hypertensive with generalized atherosclerosis, two had diabetes mellitus, and one had undergone coronary artery bypass some years earlier and had non-dialytic chronic renal insufficiency. Symptoms of brain ischemia were present in two patients. All patients had total occlusion of the common carotid, extending from the origin to the bifurcation and localized in the right common carotid in two cases. In two cases the internal carotid artery was also occluded. MAIN MEASUREMENTS: Postoperative early mortality and stroke rate, and the medium and long-term endarterectomy patency. RESULTS: There were no deaths. One patient had a transient ischemic attack. All endarterectomies were patent after eight months, four years and seven years of follow-up. CONCLUSION: There is low mortality, and the procedure can be done through only one cervical incision. Tandem lesions of the carotid arteries can be treated together. It is suitable for long total occlusions of the common carotid, and long-term patency.

Download Full-text

Acute myocardial infarction from simultaneous total occlusion of the left circumflex and right coronary artery. A case report

International Journal of Cardiology ◽

10.1016/j.ijcard.2007.02.056 ◽

2007 ◽

Vol 119 (2) ◽

pp. e65-e67 ◽

Cited By ~ 12

Author(s):

Wissam Derian ◽

Anna Hertsberg

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Case Report ◽

Coronary Artery ◽

Right Coronary Artery ◽

Total Occlusion

Download Full-text

A COVID-19 patient with recurrent acute limb ischaemia despite two successive types of therapeutic dose anticoagulation and thrombolysis

BMJ Case Reports ◽

10.1136/bcr-2021-245040 ◽

2021 ◽

Vol 14 (8) ◽

pp. e245040

Author(s):

Eva Teng ◽

Marcelle Pignanelli ◽

Faiza Hammad ◽

David Wisa

Keyword(s):

Lower Limb ◽

Arterial Thrombosis ◽

Distress Syndrome ◽

Respiratory Illness ◽

Limb Ischaemia ◽

Heparin Infusion ◽

Recurrent Ischaemia ◽

Acute Limb Ischaemia ◽

Upper Respiratory ◽

Infusion Protocol

COVID-19 is caused by the SARS-CoV-2, and its presentation ranges from mild upper respiratory illness to critical disease including acute respiratory distress syndrome and multiorgan dysfunction. While it was initially believed to primarily target the respiratory system, numerous studies have demonstrated it to cause a hypercoagulable state that predisposes to arterial and venous thrombosis. We present a case where a patient with COVID-19 developed acute lower limb ischaemia due to arterial thrombosis in the setting of full-dose enoxaparin, followed by heparin infusion protocol. The patient developed recurrent ischaemia despite thrombolysis in addition to anticoagulation, and eventually required open thrombectomy before making a full recovery.

Download Full-text