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Free-floating thrombus in the right common carotid artery
Journal of Cardiology (2009) 54, 304—306
CASE REPORT
Free-floating thrombus in the right common carotid artery Eiji Taguchi (MD) a,∗, Kazuhiro Nishigami (MD, FJCC) a, Takihiro Kamio (MD) b, Takashi Honda (MD, FJCC) a, Koichi Nakao (MD, FJCC) a a Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, 5-3-1 Chikami, Kumamoto, Japan b Division of Pathology, Saiseikai Kumamoto Hospital Laboratory Center, 5-3-1 Chikami, Kumamoto, Japan
Received 29 October 2008 ; received in revised form 18 November 2008; accepted 21 November 2008 Available online 3 February 2009 KEYWORDS Aortic diseases; Stroke; Thromboembolism
Summary We report the case with type A acute aortic dissection that vascular echo disclosed a free-floating thrombus in the right common carotid artery. © 2008 Japanese College of Cardiology. Published by Elsevier Ireland Ltd. All rights reserved.
A 73-year-old woman was admitted to our hospital because of chest pain and left-sided hemiplegia. On the physical examination at the admission, the state of consciousness was disturbed severely and right-sided conjugate deviation was observed. Diastolic murmur was auscultated at the third left sternal border. A 12-lead electrocardiogram showed no obvious abnormalities. Blood chemistry examination showed that the serum level of D-dimer, FDP, and fibrinogen were 142 g/ml (normal range, <1.0 g/ml), 254 g/ml
∗ Corresponding author. Tel.: +81 96 351 8000; fax: +81 96 326 3045. E-mail address: [email protected] (E. Taguchi).
(<5.0 g/ml), and 123 mg/dl (186—355 mg/dl), respectively. Transthoracic echocardiography with color Doppler study exhibited an intimal flap in the dilatated ascending aorta (Figure 1) and moderate aortic regurgitation. Enhanced CT showed type A aortic dissection and the involvement of right brachiocephalic artery (Figure 2). Vascular echo disclosed large mobile floating thrombus in the right common carotid artery (Figure 3A and B). Consequently, we diagnosed thromboembolic cerebral infarction from the thrombi in the right common carotid artery complicated with type A acute aortic dissection. Renal function gradually worsened and 8 days later after the admission, she died. The autopsy findings revealed large floating thrombi in the right common carotid artery (Figure 4A and B).
0914-5087/$ — see front matter © 2008 Japanese College of Cardiology. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.jjcc.2008.11.013
Free-floating thrombus in carotid artery with type A dissection
Figure 1 Enhanced CT demonstrates the type A aortic dissection involving the brachiocephalic artery. Note the filling defect in the right carotid artery (white arrow).
305
Figure 2 Transthoracic echocardiography disclosed the intimal flap in the ascending aorta.
Figure 3 (A) The long axis view of the right common carotid artery. Vasucular echo showed a large floating thrombus at the distal site of the dissecting common carotid artery. (B) The short axis view of the right common carotid artery (right: M-mode, left: two-dimensional image). View image demonstrates a mobile floating large thrombus.
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Figure 4 (A) Photograph during autopsy shows a large floating thrombus in the right common carotid artery (white arrow). (B) Longitudinal cut section fixed formalin demonstrates a thrombus at the distal site of dissecting lumen in the right common carotid artery (white arrow).
References Commonly, aortic dissection can induce visceral ischemia due to the involvement of the aortic side branch vessels. The present case, however, demonstrated that arterial thrombus could occur and induce thromboembolic cerebral infarction, which speculatively might be caused by the hypercoagulable status in the aortic dissection [1,2].
[1] Bhatti AF, Leon Jr LR, Labropoulos N, Rubinas TL, Rodriguez H, Kalman PG, Schneck M, Psalms SB, Biller J. Free-floating thrombus of the carotid artery: literature review and case reports. J Vas Surg 2007;45(January (1)):199—205. [2] Charly G, Wenke D, Ivar F, Joachim S, Frank JE. Neurological symptoms in type A aortic dissections. Stroke 2007;38:292—7.
Available online at www.sciencedirect.com
CASE REPORT
Free-floating thrombus in the right common carotid artery Eiji Taguchi (MD) a,∗, Kazuhiro Nishigami (MD, FJCC) a, Takihiro Kamio (MD) b, Takashi Honda (MD, FJCC) a, Koichi Nakao (MD, FJCC) a a Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, 5-3-1 Chikami, Kumamoto, Japan b Division of Pathology, Saiseikai Kumamoto Hospital Laboratory Center, 5-3-1 Chikami, Kumamoto, Japan
Received 29 October 2008 ; received in revised form 18 November 2008; accepted 21 November 2008 Available online 3 February 2009 KEYWORDS Aortic diseases; Stroke; Thromboembolism
Summary We report the case with type A acute aortic dissection that vascular echo disclosed a free-floating thrombus in the right common carotid artery. © 2008 Japanese College of Cardiology. Published by Elsevier Ireland Ltd. All rights reserved.
A 73-year-old woman was admitted to our hospital because of chest pain and left-sided hemiplegia. On the physical examination at the admission, the state of consciousness was disturbed severely and right-sided conjugate deviation was observed. Diastolic murmur was auscultated at the third left sternal border. A 12-lead electrocardiogram showed no obvious abnormalities. Blood chemistry examination showed that the serum level of D-dimer, FDP, and fibrinogen were 142 g/ml (normal range, <1.0 g/ml), 254 g/ml
∗ Corresponding author. Tel.: +81 96 351 8000; fax: +81 96 326 3045. E-mail address: [email protected] (E. Taguchi).
(<5.0 g/ml), and 123 mg/dl (186—355 mg/dl), respectively. Transthoracic echocardiography with color Doppler study exhibited an intimal flap in the dilatated ascending aorta (Figure 1) and moderate aortic regurgitation. Enhanced CT showed type A aortic dissection and the involvement of right brachiocephalic artery (Figure 2). Vascular echo disclosed large mobile floating thrombus in the right common carotid artery (Figure 3A and B). Consequently, we diagnosed thromboembolic cerebral infarction from the thrombi in the right common carotid artery complicated with type A acute aortic dissection. Renal function gradually worsened and 8 days later after the admission, she died. The autopsy findings revealed large floating thrombi in the right common carotid artery (Figure 4A and B).
0914-5087/$ — see front matter © 2008 Japanese College of Cardiology. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.jjcc.2008.11.013
Free-floating thrombus in carotid artery with type A dissection
Figure 1 Enhanced CT demonstrates the type A aortic dissection involving the brachiocephalic artery. Note the filling defect in the right carotid artery (white arrow).
305
Figure 2 Transthoracic echocardiography disclosed the intimal flap in the ascending aorta.
Figure 3 (A) The long axis view of the right common carotid artery. Vasucular echo showed a large floating thrombus at the distal site of the dissecting common carotid artery. (B) The short axis view of the right common carotid artery (right: M-mode, left: two-dimensional image). View image demonstrates a mobile floating large thrombus.
306
E. Taguchi et al.
Figure 4 (A) Photograph during autopsy shows a large floating thrombus in the right common carotid artery (white arrow). (B) Longitudinal cut section fixed formalin demonstrates a thrombus at the distal site of dissecting lumen in the right common carotid artery (white arrow).
References Commonly, aortic dissection can induce visceral ischemia due to the involvement of the aortic side branch vessels. The present case, however, demonstrated that arterial thrombus could occur and induce thromboembolic cerebral infarction, which speculatively might be caused by the hypercoagulable status in the aortic dissection [1,2].
[1] Bhatti AF, Leon Jr LR, Labropoulos N, Rubinas TL, Rodriguez H, Kalman PG, Schneck M, Psalms SB, Biller J. Free-floating thrombus of the carotid artery: literature review and case reports. J Vas Surg 2007;45(January (1)):199—205. [2] Charly G, Wenke D, Ivar F, Joachim S, Frank JE. Neurological symptoms in type A aortic dissections. Stroke 2007;38:292—7.
Available online at www.sciencedirect.com