Key result
Percutaneous transluminal angioplasty and Fogarty embolectomy successfully restored blood flow and improved ejection fraction from 32% to 50% in a 26-year-old male with malignant hypertension.
Why the study?
Malignant hypertension often causes multiorgan failure, but the development of a left ventricular thrombus and subsequent acute limb ischemia is rare.
Case Report (n=1)
This case highlights the rare occurrence of left ventricular thrombus and acute limb ischemia secondary to malignant hypertension, emphasizing the need for timely intervention.
Answers are grounded in this paper and cite their sources.
May prompt evaluation for malignant hypertension in LV thrombus with limb ischemia; leaves open generalizability from this single case.
RATIONALE: Malignant hypertension (MHT) is characterized by a systolic blood pressure (BP) of ≥ 180 mm Hg and/or a diastolic BP of ≥120 mm Hg, accompanied by acute target organ damage. While it often results in multiorgan failure, the development of a left ventricular (LV) thrombus and subsequent acute limb ischemia (ALI) is rare. PATIENT CONCERNS: A 26-year-old Korean male with untreated hypertension presented with MHT and discoloration of the right lower extremity. The affected limb exhibited classic signs of ALI. DIAGNOSES: Computed tomography angiography revealed a right renal infarction and total occlusion of the right distal superficial femoral artery. Echocardiography demonstrated a reduced ejection fraction of 32% and a LV thrombus. Hybrid 18-fluoro-deoxyglucose (FDG) positron emission tomography/magnetic resonance imaging revealed no abnormal FDG uptake or late gadolinium enhancement, ruling out myocardial inflammation, fibrosis, or scarring and confirming MHT as the cause of LV dysfunction and thrombus. INTERVENTIONS: The patient underwent percutaneous transluminal angioplasty and Fogarty embolectomy, successfully restoring blood flow. Fasciotomy was performed to manage reperfusion injury. OUTCOMES: The symptoms and blood flow in the right lower extremity were restored. Follow-up echocardiography showed an improved ejection fraction of 50% and resolution of the LV thrombus. The patient continued to improve, was discharged, and is currently undergoing rehabilitation therapy. LESSONS: Hypertension should be proactively managed to prevent life-threatening complications. Timely intervention, particularly in cases of severe complications, is essential for optimizing patient outcomes.
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Jeong et al. (2025) conducted a case report in Malignant hypertension with multiorgan failure and acute limb ischemia (n=1). Percutaneous transluminal angioplasty, Fogarty embolectomy, and fasciotomy was evaluated on Restoration of blood flow and symptom resolution. Percutaneous transluminal angioplasty and Fogarty embolectomy successfully restored blood flow and improved ejection fraction from 32% to 50% in a 26-year-old male with malignant hypertension.
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