Key result
Diagnostic cardiac catheterization in a diseased aorta linked to delayed renal infarction four months post-procedure.
Case Report (n=1)
No
This case highlights the risk of delayed atheroembolic and thromboembolic complications, such as renal infarction, following cardiac catheterization in patients with a diffusely diseased aorta.
Delayed renal infarction may occur months after catheterization in diffusely diseased aortas; single case leaves incidence and prevention open.
A 45-year-old Nepalese refugee was admitted with complaints of abdominal pain of one day duration, associated with radiating pain from loin to groin.The patient's medical history was significant for diabetes mellitus, hypertension, hyperlipidemia and a recent diagnostic cardiac catheterization 4 months previously.Initial imaging revealed a wedgeshaped hypodensity (Picture 1) in the right kidney compatible with an infarct and multiple low density lesions in the spleen suggestive of embolic lesions.CT angiography (Picture 2) confirmed the renal infarct, demonstrated the presence of an intramural thrombus in the descending thoracic aorta (Picture 3) and evidence of significant atherosclerosis.Transesophageal echocardiogram (TEE) confirmed a mobile thrombus in the proximal descending aorta.Otherwise, hypercoagulability work-up remained negative.This patient was started on anticoagulation and on follow-up has had no further episodes.Renal infarction secondary to thromboembolism from the aorta is a well described phenomenon.Treatment in cases secondary to mobile aortic thrombi is uncertain.Therapeutic options include surgical removal, thrombectomy or embolectomy, thrombolysis or anticoagulation (1).In general, the outcome in cases of renal infarction is favorable.
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Das et al. (2011) conducted a case report in Renal infarction and aortic thrombus (n=1). Cardiac catheterization was evaluated on Development of renal infarction. Diagnostic cardiac catheterization in a patient with a diffusely diseased aorta resulted in a delayed renal infarction from an aortic thrombus four months post-procedure.
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