SHM Converge Scientific Abstract ePoster Gallery-A Case of Multiple Embolic Infarcts in a Patient With Abdominal Pain

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A 64-year-old woman with a history of right renal transplant and Crohn’s disease presented with five days of severe abdominal pain, nausea, vomiting, chills, and abdominal distention. Initial evaluation showed hypotension, leukocytosis, elevated lactate, and acute kidney injury. CT angiography of the abdomen and pelvis revealed wedge-shaped infarcts in the transplanted kidney and spleen, raising concern for embolic or hypoperfusion-related injury. She was started on heparin and broad-spectrum antibiotics for presumed sepsis.<br /><br />Despite initial stabilization, she later developed sudden left arm pain, numbness, weakness, and absent pulses. CTA of the chest and left upper extremity demonstrated filling defects in the aortic arch and occlusion of the left brachial artery, prompting urgent surgical thromboembolectomy. Transesophageal echocardiography then revealed multiple large mobile thrombi in the transverse and descending aorta. She was transitioned to warfarin in addition to heparin and ultimately discharged after recovery.<br /><br />This case highlights multiple aortic thrombi as the likely source of emboli causing renal, splenic, and brachial artery infarction, and possibly microembolic abdominal pain despite repeated abdominal CTAs showing no mesenteric ischemia. Her renal transplant and inflammatory bowel disease likely contributed to a hypercoagulable state. The report emphasizes that abdominal pain out of proportion to exam with lactic acidosis should prompt early CTA, and that chest CTA may be necessary to identify aortic thrombus when abdominal and solid-organ infarcts are present.

Asset Subtitle

Phillip Anjum

Meta Tag

Author List Andrew Chacko, Phillip Anjum, Sharon S. Clark

Category Clinical Vignettes

Concept Mesenteric Ischemia

Concept Pain out of proportion

Concept Computed Tomography Angiography

Concept Aortic Thrombus

Concept Hypercoagulable State

Distinguished Non-Finalist

Presenter Organization The Ohio State University College of Medicine

Presenting Author Phillip Anjum

Track Adult

Keywords

aortic thrombus

renal transplant

splenic infarction

brachial artery occlusion

embolism

hypercoagulable state

Crohn's disease

lactic acidosis

CT angiography

thromboembolectomy

Mesenteric Ischemia

Pain out of proportion

Computed Tomography Angiography

Aortic Thrombus

Hypercoagulable State