Abdominal aortic thrombosis as initial presentation of COVID-19 infection: A case report

BACKGROUND The hypercoagulable state associated with coronavirus disease 2019(COVID-19)has been shown to complicate the course of this viral illness with both venous and arterial clots.Often presenting after hospitalization and known COVID-19 diagnosis,the etiology of thrombosis has been attributed to the hyperinflammatory state and endothelial dysfunction associated with COVID-19.This report portrays a patient who experienced an aortic thrombosis resulting in back and leg pain with subsequent loss of motor function of his legs as his initial presentation of COVID-19.CASE SUMMARY Patient is a 60-year-old Caucasian male with no medical history who presented with sudden onset pain in his lower back and lower extremities.He went on to experience complete motor loss of the lower extremities two hours after admission.Chest pain and shortness of breath developed one day later but were not present at time of presentation.Computed tomography angiography of the chest,abdomen,and pelvis revealed occlusion by thrombosis of the abdominal aorta in addition to multifocal pulmonary ground-glass opacities prompting COVID-19 PCR,which was positive.He was taken to surgery for attempted thrombectomy and the thrombus was retrieved starting from the right common femoral artery,but a second thrombus had immediately reformed in place of the prior thrombectomy site resulting in conclusion of the procedure.He was continued on unfractionated heparin and received a dose of tocilizumab 400 mg,but rapidly developed hemodynamic compromise and expired from cardiac arrest.CONCLUSION This presentation emphasizes the importance of evaluating patients for COVID-19 who experience unusual thromboses without superior explanation.

Neonatal necrotizing enterocolitis caused by umbilical arterial catheter-associated abdominal aortic embolism:A case report

BACKGROUND Reports of necrotizing enterocolitis(NEC)caused by umbilical arterial catheter(UAC)-associated abdominal aortic embolism in neonates are rare.Herein,we report the case of an extremely low birth weight(ELBW)infant with NEC caused by UAC-associated abdominal aortic embolism.CASE SUMMARY A female infant,aged 21 min and weighing 830 g at 28+6 wk of gestational age,was referred to our hospital because of premature birth and shallow breathing.The patient was diagnosed with ELBW,neonatal respiratory distress syndrome,neonatal intrauterine infection,and neonatal asphyxia.Umbilical arterial and venous catheters were inserted on the day after birth and were removed 9 d later,according to the doctor’s plan.Within 48 h after extubation,the patient’s manifestations included poor responsiveness,heart rate range of 175-185/min,and currant jelly stool.Therefore,we considered a diagnosis of NEC.To determine the cause,we used B-mode ultrasound,which revealed a partial abdominal aortic embolism(2 cm×0.3 cm)and abdominal effusion.The patient was treated with nil per os,gastrointestinal decompression,anti-infective therapy,blood transfusion,and low-molecular-weight heparin sodium q12h for anticoagulant therapy(from May 20 to June 1,the dosage of low-molecular-weight heparin sodium was adjusted according to the anti-Xa activity during treatment).On the 67th day after admission,the patient fully recovered and was discharged.CONCLUSION The abdominal aortic thrombosis in this patient was considered to be catheter related,which requires immediate treatment once diagnosed.The choice of treatment should be determined according to the location of the thrombus and the patient’s condition.