Abdominal aortic thrombus formation in a neonate with an interrupted aortic arch

Abstract

We note the risk of paradoxical embolism in patients with congenital heart defects with a right-to-left shunt. These patients should be managed to ensure that abdominal aortic thrombi are not overlooked when their clinical conditions change.

Keywords: abdominal aortic thrombus; congenital cardiac defects; interrupted aortic arch; neonate; paradoxical embolism.

FIGURE 1

Abdominal ultrasound images from a patient with continuous hematochezia. A: Sagittal view of the middle abdomen. A large thrombus (arrow) is attached to the orifice of the celiac trunk and extends to the bifurcation of the iliac arteries. B: Axial view of the middle abdomen. The thrombus almost completely occupies the aorta. C: Axial view of the abdomen at a lower level than that in panel B. A small 1‐mm thrombus (white arrowhead) is detected in the IVC. D: One month after heparin treatment, the large thrombus is reduced to a thrombus 1 mm in diameter and is fixed on the intima of the aorta. Hyperechonic structure suggests the thrombus organized. Ao: aorta, SMA: superior mesenteric artery, and IVC: inferior vena cava

FIGURE 2

Schema of the suspected mechanism causing a thrombus in the abdominal aorta in this case. ① PICC‐related thrombus is formed in the venous system. ② The clot travels into the heart and is trapped in the main PA; ③ the clot migrates into the artery via the DA. ③ Bilateral PA banding suppresses PA flow. ④ The thrombus is fixed on the orifice of the SMA. PICC: peripherally inserted central catheter, PA: pulmonary artery, Ao: aorta, SMA: superior mesenteric artery, IVC: inferior vena cava, and DA: ductus arteriosus