Mando Ramy, Gemayel Robert, Chaddha Ashish, Barbat Julian J, Cami Elvis
Department of Internal Medicine, Beaumont Health System, Royal Oak, MI, USA.
Michigan State University College of Osteopathic Medicine, Lansing, MI, USA.
Case Rep Cardiol. 2019 Jul 2;2019:8132578. doi: 10.1155/2019/8132578. eCollection 2019.
Primary aortic thrombus is an uncommon entity and not frequently reported in the literature. Herein, we discuss the presentation and management of a patient with a primary thoracic mural thrombus.
A 46-year-old female with past medical history of tobacco dependence presented for low-grade fever and sudden onset, severe right upper quadrant abdominal pain with associated nausea and vomiting. Computed tomography (CT) revealed an intraluminal polypoid filling defect arising from the isthmus of the aorta projecting into the proximal descending aorta and findings consistent with infarction of the spleen and right kidney. Infectious, autoimmune, hematologic, and oncologic work-up were all unyielding. The patient was started on heparin and later transitioned to apixaban 5 mg twice a day and 81 mg of aspirin daily. She was also counseled regarding smoking cessation. Two months follow-up CT revealed resolution of the thrombus. Patient had no further thromboembolic complications.
We present a unique case of primary aortic thrombus. To our knowledge, this is the first reported case managed successfully with a NOAC. This diagnosis is one of exclusion and through work-up should be completed. Our aim is to raise awareness of this condition and successful management with apixaban in low-risk patients.
原发性主动脉血栓是一种罕见的病症，文献中报道较少。在此，我们讨论一例原发性胸壁血栓患者的临床表现及治疗。
一名46岁有烟草依赖病史的女性，因低热、突发严重右上腹腹痛伴恶心呕吐就诊。计算机断层扫描（CT）显示主动脉峡部有一腔内息肉样充盈缺损，延伸至近端降主动脉，同时发现脾脏和右肾梗死。感染、自身免疫、血液学及肿瘤学检查均无阳性发现。患者开始使用肝素治疗，后转为阿哌沙班，每日两次，每次5毫克，同时每日服用81毫克阿司匹林。患者还接受了戒烟咨询。两个月后的随访CT显示血栓溶解。患者未出现进一步的血栓栓塞并发症。
我们报告了一例独特的原发性主动脉血栓病例。据我们所知，这是首例成功使用新型口服抗凝药（NOAC）治疗的病例。该诊断需排除其他疾病，应完善相关检查。我们的目的是提高对这种疾病的认识，以及阿哌沙班在低风险患者中的成功治疗经验。
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