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Case Reports
. 2021 Apr 30;21(1):220.
doi: 10.1186/s12872-021-02031-4.

A case report of acute Leriche syndrome: aortoiliac occlusive disease due to embolization from left ventricular thrombus caused by myocarditis

Abudi Mohamed  1 , Gustav Mattsson  2 , Peter Magnusson  1   3
Affiliations
Case Reports

A case report of acute Leriche syndrome: aortoiliac occlusive disease due to embolization from left ventricular thrombus caused by myocarditis

Abudi Mohamed et al. BMC Cardiovasc Disord. .

Abstract

Background: Leriche syndrome is the triad of symptoms consisting of claudication, erectile dysfunction, and absence of femoral pulses. Inflammatory disease of the heart muscle, myocarditis, may occur because of immune system activation, drug exposure or infections.

Case presentation: A 31-year-old man with no previous medical history presented to the emergency department with acute back pain that had started suddenly during weightlifting, which was initially misdiagnosed as spinal disc herniation. The patient returned four hours later and a thoracoabdominal computed tomography showed a large thrombus in the aortoiliac region creating a total occlusion. Vascular surgery with embolectomy was immediately performed. Further investigation with echocardiography revealed deteriorated systolic dysfunction with marked hypokinesia and two large thrombi in the left ventricle. Cardiac magnetic resonance imaging showed late contrast enhancement of the inferolateral and septal regions, which indicated a recent myocarditis.

Conclusion: Myocarditis can result in multiple embolization with diverse organ manifestation including total occlusion of the aortoiliac arteries, which required urgent embolectomy.

Keywords: Aortoiliac occlusive disease; Cardiac embolization; Case report; Embolectomy; Heart failure; Leriche syndrome; Myocarditis.

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Conflict of interest statement

AM declare no competing interests. GM has received speaker’s fee from Alnylam, MSD, and Internetmedicin. PM has received speaker’s fees or grants from Abbott, Alnylam, Amicus Therapeutics, AstraZeneca, Bayer, Boehringer-Ingelheim, Coala Life, Internetmedicin, Lilly, MSD, Novo Nordisk, Octopus Medical, Orion Pharma, Pfizer, Vifor Pharma, and Zoll.

Figures

Fig. 1
Fig. 1
Thoracoabdominal computed tomography in coronal view during visit in the emergency department showing a massive thrombus in the aortoiliac region
Fig. 2
Fig. 2
Echocardiography in parasternal short axis view performed post-operatively showing a large thrombus in the left ventricle
Fig. 3
Fig. 3
Echocardiography in parasternal long axis view performed post-operatively showing a large thrombus in the left ventricle
Fig. 4
Fig. 4
Cardiac magnetic resonance image in short axis view performed on the second day of admission demonstrating a thrombus in the left ventricle
Fig. 5
Fig. 5
Cardiac magnetic resonance image in short axis view showing subepicardial late gadolinium enhancement in the interventricular septum suggesting previous myocarditis
Fig. 6
Fig. 6
Cardiac magnetic resonance image in four chamber view showing subepicardial late gadolinium enhancement in the interventricular septum suggesting previous myocarditis
See this image and copyright information in PMC

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