Search

Antiphospholipid syndrome is a thrombotic disorder in which the clinical features are venous and/or arterial thrombosis, thrombocytopenia, and recurrent fetal loss. We describe the case of a 39-year-old woman affected by antiphospholipid syndrome and acute anterior myocardial infarction complicated by cardiogenic shock. The patient, after the failure of thrombolysis, was successfully treated by rescue angioplasty. The persistent thrombocytopenia of these patients may lead to safety problems in thrombolytic treatment; therefore, primary angioplasty may be considered the treatment of choice.

We describe the case of a middle-aged woman with massive thrombosis of the aortic bifurcation, treated with emergency surgery. The patient was later evaluated by transthoracic echocardiography, which resulted normal, and by transesophageal echocardiography, which demonstrated a huge thrombus in the lumen of the descending thoracic aorta, in the absence of gross vessel wall abnormalities. Thus, the patient underwent a second surgical intervention and the thrombus was successfully removed. The episode led us to review the medical literature about cases of thrombosis and embolization originating from macroscopically normal aortas. This review underscores the diagnostic yield of the transesophageal study of the aorta in patients with systemic embolization (particularly in the presence of risk factors for atherosclerosis) and supports a wider indication of transesophageal echocardiography in the evaluation of systemic embolizating syndromes.