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Aortic thrombus and pulmonary embolism in a patient with hyperhomocysteinemia

Nature Clinical Practice Cardiovascular Medicine volume 3, pages 396–399 (2006)Cite this article

Abstract

Background A 32-year-old man presented at hospital with persistent pain, hypothermia and paraesthesia in his right leg, caused by embolic occlusion of all three large arteries as a result of massive thrombi in the abdominal aorta. Previously, the patient had been diagnosed with pulmonary embolism and admitted at least a 6-month history of alcohol abuse. Laboratory assessment of the patient's lipid levels, platelet function and coagulation factors yielded normal results. Duplex ultrasound revealed substantial media thickening of the carotid and femoral arteries, without evidence of calcification. Further laboratory tests revealed elevated plasma levels of homocysteine, asymmetric dimethylarginine, symmetric dimethylarginine and 8-isoprostaglandin F2α.

Investigations Physical examination, laboratory analyses, bronchoscopy, duplex ultrasonography, CT scan and CT angiography

Diagnosis Severe hyperhomocysteinemia associated with acute aortic thrombi and peripheral emboli

Management Diet supplementation with folic acid, vitamin B6 and vitamin B12, low-molecular-weight heparin and L-arginine.

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Figure 1: Necrotic lesions in the patient's feet at presentation
Figure 2: Computer tomography of the patient's abdomen
Figure 3: Light reflex rheography and oscillography demonstrating absence of perfusion in the toes of the patient's right foot

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Acknowledgements

We thank C Hedenkamp GmbH & Co. KG (Hövelhoff, Germany) for supplying the L-arginine effervescent tablets.

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Authors and Affiliations

  1. A Goette is Assistant Professor of Cardiology, M Hammwöhner is staff cardiologist, H Klein is Professor of Cardiology and SM Bode-Böger is Professor of Clinical Pharmacology at the University Hospital Magdeburg, Germany

    Andreas Goette, Matthias Hammwöhner, Helmut Klein & Stefanie M Bode-Böger

  2. J Dierkes is Assistant Professor at the Institute of Clinical Chemistry, J Lachmuth is a staff member and JC Frölich is Professor of Clinical Pharmacology at the Institute of Clinical Pharmacology at Hannover Medical School, Germany

    Jutta Dierkes, Jessica Lachmuth & Jürgen C Frölich

Authors
  1. Andreas Goette
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  2. Matthias Hammwöhner
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  3. Jutta Dierkes
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  4. Jessica Lachmuth
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  5. Jürgen C Frölich
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  6. Helmut Klein
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  7. Stefanie M Bode-Böger
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Corresponding author

Correspondence to Andreas Goette.

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The authors declare no competing financial interests.

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Goette, A., Hammwöhner, M., Dierkes, J. et al. Aortic thrombus and pulmonary embolism in a patient with hyperhomocysteinemia. Nat Rev Cardiol 3, 396–399 (2006). https://doi.org/10.1038/ncpcardio0601

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