An 85-year-old patient with a remote history of venous thromboembolism, coronary artery disease and essential thrombocytosis presented with symptoms of abdominal pain, fever, vomiting and diarrhea.
Essential thrombocytosis is an uncommon disorder in which the body produces too many blood platelets. The condition causes patients to feel lightheaded and fatigued, they may also experience associated vision changes and headaches. The condition also increases your risk of blood clots. The condition is more common in people over 50-years of age. However, there is a chance that younger people might develop it too. Moreover, it more commonly affects women. The disease has no cure and the symptoms may range from mild to severe. In case of a mild form of the disease, you may not need treatment. If the condition is severe, you may need blood thinners and medication to lower your platelet count or both.
Physical examination of the patient revealed guarding and tenderness in the lower abdomen. According to the laboratory results, the white blood cell count was 11,800 per cubic millimeter (reference range, 3400 to 8200), a D-dimer level of 6.7 mg per liter (reference range, <0.5), a platelet count of 562,000 per cubic millimeter (reference range, 150,000 to 360,000), and a lactate level of 0.8 mmol per liter (reference range, 0.5 to 2.2).
CT Scan of the patient’s abdomen revealed four intraaortic thrombi that were attached to the wall of the descending aorta. Magnetic resonance confirmed the findings. The intraaortic thrombi moved in synchronization with the cardiac cycle. Other findings included multiple infarctions of the spleen and edema of the small bowel mesentery. Owing to the possibility of mesentric ischemia, an exploratory laparotomy was performed. However, no ischemia was found.
Development of mobile thrombi
The development of mobile thrombi in the aorta is a rare possibility. However, it is a possible mechanism of thrombus formation on top of atherosclerotic plaques. The patient was put under anticoagulation therapy. Repeated imaging showed a decrease in the size of the thrombi.
Unfortunately, the patient died approximately a month after the initial presentation because of the development of cadidemia.
References
Sallinen, V., & Vikatmaa, P. (2017). Mobile Aortic Thrombi. The New England journal of medicine, 377(2).
