The presentations of cardiac myxoma are diverse, from asymptomatic to a variety of symptoms due to embolisation. Total occlusion of the abdominal aorta due to embolisation of an atrial myxoma is a rare but lifethreatening event which demands an urgent diagnosis and prompt intervention with embolectomy.In this paper a patient with acute onset paraplegia is presented. CT angiography revealed a large totally occlusive thrombus in the infrarenal abdominal aorta extending into the common iliac arteries. A thrombus in the left atrium was identified as the source of the embolus.Keywords: Atrial myxoma; Acute occlusion of abdominal aorta; Acute Leriche syndrome; TakotsuboCardiomyopathy Case ReportA 68-year-old patient was admitted to the emergency department after a fall during a bike ride because of sudden dizziness. Initially she only had a feeling of discomfort and weakness in the lower extremities en was still able to stand. Shortly afterwards this progressed to paralysis in both legs. Her medical history included diabetes mellitus and active smoking. On admission, the patient was in poor clinical condition with mild tachycardia and fluctuations in blood pressure. She was confused, anxious and sweaty but obeying commands. Clinical examination showed pallor, coldness and paralysis of both legs. Femoral, popliteal and pedal pulses were absent. CT angiography revealed a large totally occlusive thrombus in the infrarenal abdominal aorta extending into the common iliac arteries. A thrombus in the left atrium was identified as the source of the embolus (Figures 1 and 2). Electrocardiography showed ST-segment elevation, consistent with an acute lateral myocardial infarction, and the patient had significantly elevated Troponin I levels. ProcedureIntravenous heparin infusion was started and the patient was transferred to the operation theatre for a bilateral transfemoral embolectomy.Longitudinal groin incisions were made to expose the common femoral arteries and their bifurcation. A size 5 Fogarty was then passed up to the aorta bilaterally with retrieval of a transparent, gelatinous embolus. Biopsies were taken. There was no retrieval of any thrombus distally but there was adequate backflow. Closure of the femoral arteries was done with patch angioplasty after endarterectomy because of severe occlusive pathology. Fasciotomy was not considered because there were no signs of compartment syndrome in the lower extremities. At the end of the procedure both lower extremities were warm and had good capillary refill.