Abstract
Background: Coronavirus disease 2019 (COVID-19) is associated with endothelial inflammation and a hypercoagulable state resulting in both venous and arterial thromboembolic complications. We present a case of COVID-19-associated aortic thrombus in an otherwise healthy patient.
Case report: A 53-year-old woman with no past medical history presented with a 10-day history of dyspnea, fever, and cough. Her pulse oximetry on room air was 84%. She tested positive for severe acute respiratory syndrome coronavirus 2 infection, and chest radiography revealed moderate patchy bilateral airspace opacities. Serology markers for cytokine storm were significantly elevated, with a serum D-dimer level of 8180 ng/mL (normal < 230 ng/mL). Computed tomography of the chest with i.v. contrast was positive for bilateral ground-glass opacities, scattered filling defects within the bilateral segmental and subsegmental pulmonary arteries, and a large thrombus was present at the aortic arch. The patient was admitted to the intensive care unit and successfully treated with unfractionated heparin, alteplase 50 mg, and argatroban 2 μg/kg/min. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Mural aortic thrombus is a rare but serious cause of distal embolism and is typically discovered during an evaluation of cryptogenic arterial embolization to the viscera or extremities. Patients with suspected hypercoagulable states, such as that encountered with COVID-19, should be screened for thromboembolism, and when identified, aggressively anticoagulated.
Keywords: COVID-19; aortic thrombus; arterial thromboembolism; hypercoagulable state.
【저자키워드】 COVID-19, aortic thrombus, arterial thromboembolism, hypercoagulable state., 【초록키워드】 coronavirus disease, Inflammation, Coronavirus disease 2019, Cytokine storm, coronavirus, intensive care, pulse oximetry, Infection, intensive care unit, tomography, cytokine, heparin, severe acute respiratory syndrome Coronavirus, cough, Computed tomography, serum, Ground-glass opacities, Chest, Fever, Dyspnea, Patient, Thromboembolism, Thrombus, respiratory, moderate, Hypercoagulable state, Chest radiography, marker, Embolism, D-dimer level, hypercoagulable, medical history, argatroban, room air, pulmonary arteries, hypercoagulable states, aortic arch, filling defects, unfractionated heparin, endothelial, acute respiratory syndrome, thromboembolic complications, positive, past medical history, venous, alteplase, extremities, normal, viscera, resulting, tested, significantly, healthy, elevated, screened, treated, distal, Mural, patchy, subsegmental, with COVID-19, 【제목키워드】 pulmonary, arch,