Aortic thrombus and pulmonary embolism in a patient with hyperhomocysteinemia

Abstract

Background: A 32-year-old man presented at hospital with persistent pain, hypothermia and paraesthesia in his right leg, caused by embolic occlusion of all three large arteries as a result of massive thrombi in the abdominal aorta. Previously, the patient had been diagnosed with pulmonary embolism and admitted at least a 6-month history of alcohol abuse. Laboratory assessment of the patient's lipid levels, platelet function and coagulation factors yielded normal results. Duplex ultrasound revealed substantial media thickening of the carotid and femoral arteries, without evidence of calcification. Further laboratory tests revealed elevated plasma levels of homocysteine, asymmetric dimethylarginine, symmetric dimethylarginine and 8-isoprostaglandin F2alpha.

Investigations: Physical examination, laboratory analyses, bronchoscopy, duplex ultrasonography, CT scan and CT angiography.

Diagnosis: Severe hyperhomocysteinemia associated with acute aortic thrombi and peripheral emboli.

Management: Diet supplementation with folic acid, vitamin B6 and vitamin B12, low-molecular-weight heparin and L-arginine.