Thurston Alexander J F, Chapman Andrew R, Bing Rong
Edinburgh Heart Centre, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Rd, Edinburgh, EH16 4SA, UK.
Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
Eur Heart J Case Rep. 2023 Oct 10;7(10):ytad492. doi: 10.1093/ehjcr/ytad492. eCollection 2023 Oct.
Aortic mural thrombus is a rare acute aortic syndrome that can present with embolism to a distal organ. No guidelines or randomized evidence exist to guide therapy for patients with aortic mural thrombus. Cardiac and cerebral embolism is a particularly unusual presentation of aortic thrombus but has significant implications for patient management.
We present an unusual case of a young patient with simultaneous embolization of aortic thrombus to the coronary and cerebral vasculature, causing cerebral infarcts and a myocardial infarction. He presented with chest pain, slurred speech, right homonymous hemianopia, and inferior ST-elevation on electrocardiogram (ECG). Bedside echocardiography identified an inferoseptal regional wall motion abnormality. Emergent computerised tomography (CT) brain and aorta showed acute cerebral infarcts and aortic mural thrombus. He was managed medically with anticoagulation and discharged without disability after a period of rehabilitation.
This case demonstrates the value of careful clinical assessment in the setting of ST-elevation prior to transferring a patient for invasive angiography, as well as highlighting the role of echocardiography and CT imaging in the diagnosis of acute aortic syndromes. We describe the various management options for aortic mural thrombus, the role of multi-disciplinary decision-making, and our rationale for selecting a strategy of anticoagulation.
主动脉壁血栓是一种罕见的急性主动脉综合征，可表现为远端器官栓塞。目前尚无指南或随机证据可指导主动脉壁血栓患者的治疗。心脏和脑栓塞是主动脉血栓一种特别不常见的表现，但对患者管理具有重要意义。
我们报告了一例年轻患者的罕见病例，该患者主动脉血栓同时栓塞至冠状动脉和脑血管，导致脑梗死和心肌梗死。他表现为胸痛、言语不清、右侧同向性偏盲以及心电图（ECG）下ST段抬高。床旁超声心动图检查发现下间隔局部室壁运动异常。急诊脑部和主动脉计算机断层扫描（CT）显示急性脑梗死和主动脉壁血栓。他接受了抗凝药物治疗，并在一段时间的康复后出院，未遗留残疾。
该病例证明了在将患者转至进行有创血管造影之前，在ST段抬高情况下进行仔细临床评估的价值，同时突出了超声心动图和CT成像在急性主动脉综合征诊断中的作用。我们描述了主动脉壁血栓的各种管理选择、多学科决策的作用以及我们选择抗凝策略的理由。
