Massive Thoracoabdominal Aortic Thrombosis in a Patient with Iatrogenic Cushing Syndrome

Kim, Dong Hun; Choi, Dong Hyun; Lee, Young Min; Kang, Joon Tae; Chae, Seung Seok; Kim, Bo Bae; Ki, Young-Jae; Kim, Jin Hwa; Jin-Ja, Chung; Koh, Young Youp

doi:10.3348/kjr.2014.15.5.637

Cited by 4 publications

(5 citation statements)

References 8 publications

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“…She was diagnosed with acute mesenteric ischaemia and hepatic infarction. Kim et al 18 reported a case of thoracoabdominal aortic thrombosis in an 82-year-old woman with iatrogenic Cushing syndrome.…”

Section: Discussionmentioning

confidence: 99%

Arterial thrombosis as primary presentation of endogenous Cushing’s syndrome

et al. 2019

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Cushing’s syndrome is known to present with a characteristic set of clinical manifestations and complications, well described in literature. However, hypercoagulability remains an under recognised entity in Cushing’s syndrome. A 31-year-old woman from Southern India presented with history of fever, left upper quadrant pain and progressive breathing difficulty for 3 weeks. Clinical examination revealed discriminatory features of Cushing’s syndrome. Laboratory investigations showed biochemical features of endogenous ACTH-dependent Cushing’s syndrome. Imaging of the abdomen revealed splenic collection, left-sided empyema and extensive arterial thrombosis. Gadolinium enhanced dynamic MRI of the pituitary gland revealed no evidence of an adenoma while a Ga-68 DOTATATE positron emission tomography CT scan ruled out an ectopic Cushing’s. A diagnosis of endogenous Cushing’s syndrome causing a prothrombotic state with extensive arterial thrombosis was made. She was initiated on oral anticoagulation and oral ketoconazole for medical adrenal suppression. She subsequently underwent bilateral adrenalectomy and was well at follow-up.

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Section: Discussionmentioning

confidence: 99%

Arterial thrombosis as primary presentation of endogenous Cushing’s syndrome

et al. 2019

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“…Floating thrombus was also described in the case of 82 year old patient with iatrogenic Cushing's disease (after treatment for RA). The pathomechanism leading to hypercoagulation in this case was probably the increased blood platelet and von Willebrand factor activity caused by glycocortycosteroids [1].…”

Section: Discussionmentioning

confidence: 99%

“…In order to assess a thrombus in aorta the most optimal examination would be angio-CT usually preceded after the ultrasound examination [1,3]. In the case of FFT placed in the thoracic aorta the alternatives are MR, angio-MR and transesophageal echocardiography in the case of FFT placed in the thoracic aorta [2].…”

Section: Discussionmentioning

confidence: 99%

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77-year old woman with free-floating thrombus in abdominal aorta, causing acute renal dysfunction

Kupczyńska¹,

Barć²,

Antkiewicz³

et al. 2017

Acta Angiologica

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“…Thoraco-abdominal aortic thrombus leading to mesenteric ischemia is a rare presentation in the emergency department. Diagnosis requires a high index of suspicion especially in patients with risk factors, which include cardiac embolus related to arrhythmia or valvular heart disease, peripheral artery disease, vasoconstrictive medications, hemodialysis, hereditary or acquired thrombotic conditions, infections, and hypovolemia [ 2 ]. Delays in diagnosis and treatment of thrombi lead to high mortality [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Abdominal Pain Caused by Occlusion of the Celiac Trunk and Superior Mesenteric Artery in Addition to Irritable Bowel Syndrome: Case Series and Literature Review

Bakhsh¹,

Khan²,

Bashir³

2021

Cureus

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Irritable bowel syndrome (IBS) is a benign condition of the gastrointestinal tract causing abdominal pain, bloating, diarrhea, and/or constipation. Symptoms of IBS usually improve on passing flatus and defecation. There is no known identifiable underlying pathology; however, several risk factors are known to contribute to the development of IBS, which include a stressful lifestyle and certain foods such as bread, coffee, alcohol, pasta, and chocolates. Intestinal bacteria may also contribute to symptoms of IBS. IBS is diagnosed clinically and treated with various medications to control the symptoms. On the other hand, celiac and mesenteric artery thrombosis (CAMAT) is a condition that may cause significantly higher mortality and morbidity if not recognized early. CAMAT leads to the blockage of major blood vessels to the intestine and several abdominal viscera leading to abdominal pain, nausea, sweating, and, in some cases, symptoms of shock. CAMAT is most likely caused by thrombosis; however, occasionally, embolisms from distant sources in patients with atrial fibrillation can also contribute to the development of CAMAT. CAMAT is usually diagnosed with a computed tomography angiogram (CTA) and treated either surgically or medically with anticoagulants. Vascular thrombus in the thoracic and abdominal region causing ischemia of the stomach and abdominal pain in patients with a history of IBS can easily be missed and cause grave complications with high morbidity and mortality. We present two cases who were initially diagnosed and treated for IBS and later diagnosed with serious intra-abdominal pathology of CAMAT thrombosis.The first case is of a 55-year-old female who was previously diagnosed with IBS and was treated with mebeverine 200mg twice daily and esomeprazole 20mg once daily for 10 weeks. Her pain continued to get worse and she presented to the emergency department by ambulance. She underwent CTA, which showed occlusion of the celiac trunk and superior mesenteric artery causing liver and splenic infarcts. The patient received heparin and underwent a thrombectomy and embolectomy of the superior mesenteric and celiac arteries. No significant abnormality was found in the blood results. Thrombophilia screening was negative. The patient was discharged on warfarin. The second case is of a 53-year-old man who was also initially diagnosed with IBS and was treated with mebeverine 200mg twice daily for eight weeks before presenting to the emergency department with worsening abdominal pain. He underwent a CTA with contrast, which showed occlusion of the common hepatic artery and stenosis of the splenic artery leading to multiple splenic infarcts. No significant abnormality was found in blood test. Thrombophilia screening was negative. He was treated with new anticoagulant medication, dabigatran 150 mg orally twice daily.Both patients were managed with successful outcomes and were discharged home on anticoagulants. There was no recurrence of symptoms at three-month follow-up.These cases highlight that a secondary cause ...

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Massive Thoracoabdominal Aortic Thrombosis in a Patient with Iatrogenic Cushing Syndrome

Cited by 4 publications

References 8 publications

Arterial thrombosis as primary presentation of endogenous Cushing’s syndrome

Arterial thrombosis as primary presentation of endogenous Cushing’s syndrome

77-year old woman with free-floating thrombus in abdominal aorta, causing acute renal dysfunction

Abdominal Pain Caused by Occlusion of the Celiac Trunk and Superior Mesenteric Artery in Addition to Irritable Bowel Syndrome: Case Series and Literature Review

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