van Dam Lisette F, Kroft Lucia Jm, Dronkers Charlotte Ea, van Schaik Jan, van Haren Guido R, Huisman Menno V, Klok Frederikus A
Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.
Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
Eur J Case Rep Intern Med. 2020 Jan 9;7(1):001351. doi: 10.12890/2020_001351. eCollection 2020.
A 43-year-old man complaining of abdominal angina for several months showed a large suprarenal aneurysm of the abdominal aorta with extensive circumferential wall thrombosis, complete occlusion of the right renal artery and a critically stenosed left renal artery on CT angiography. He suffered from severe hypertension and renal failure. A percutaneous transluminal angioplasty (PTA) was planned. After the PTA procedure, which was complicated by the development of left renal artery occlusion, successful rescue revascularization surgery was performed. Since we were hesitant to start anticoagulant treatment because of a high bleeding risk, magnetic resonance direct thrombus imaging was performed to assess the age of the extensive arterial thrombosis. The aortic thrombus showed a low signal intensity, which is indicative of chronic rather than acute thrombosis. Therefore, oral anticoagulant treatment was not started. The patient recovered without major complications.
Accurate diagnosis and treatment of aortic intraluminal thrombosis are of the utmost importance to prevent serious complications such as (peripheral) arterial embolic occlusion with resultant ischemia.Current imaging modalities do not allow for accurate distinction between acute and chronic thrombosis in the abdominal aorta. Hence, differentiating between stable and unstable thrombosis is challenging.The non-invasive magnetic resonance direct thrombus imaging technique may be a valuable additional imaging test to establish a definitive diagnosis and treatment plan in patients with abdominal aortic thrombosis.
一名43岁男性因腹部绞痛数月前来就诊，CT血管造影显示腹主动脉有一个巨大的肾上腺旁动脉瘤，伴有广泛的环形壁血栓形成，右肾动脉完全闭塞，左肾动脉严重狭窄。他患有严重高血压和肾衰竭。计划进行经皮腔内血管成形术（PTA）。PTA术后发生左肾动脉闭塞这一并发症，随后成功实施了挽救性血管重建手术。由于出血风险高，我们对开始抗凝治疗犹豫不决，于是进行了磁共振直接血栓成像以评估广泛动脉血栓的形成时间。主动脉血栓显示为低信号强度，这表明是慢性而非急性血栓形成。因此，未开始口服抗凝治疗。患者康复，未出现重大并发症。
准确诊断和治疗主动脉腔内血栓形成对于预防严重并发症（如（外周）动脉栓塞性闭塞导致的缺血）至关重要。目前的成像方式无法准确区分腹主动脉内的急性和慢性血栓。因此，区分稳定和不稳定血栓具有挑战性。非侵入性磁共振直接血栓成像技术可能是一种有价值的额外成像检查，有助于为腹主动脉血栓形成患者制定明确的诊断和治疗方案。
