Article ; Online: Multiorgan thromboembolic shower and its ethical implications.
BMJ case reports
2021 Volume 14, Issue 2
Abstract: A 54 year-old man was admitted after being found on the floor of his home, thought to have been there for approximately 5 days. He was diagnosed with a non-ST elevation myocardial infarction and bilateral cerebral ischaemic infarcts, as well as an acute ... ...
Abstract | A 54 year-old man was admitted after being found on the floor of his home, thought to have been there for approximately 5 days. He was diagnosed with a non-ST elevation myocardial infarction and bilateral cerebral ischaemic infarcts, as well as an acute kidney injury driven by rhabdomyolysis. The following day, bilateral lower limb ischaemia was observed. A full body CT angiogram revealed a complete thromboembolic shower with bilateral arterial occlusion in the lower limbs, bilateral pulmonary emboli, a splenic infarct and mesenteric ischaemia. An echocardiogram revealed a large thrombus in the left ventricle as the likely thromboembolic source. Bilateral lower limb amputations were recommended, commencing a complex discussion regarding the best course of management for this patient. The discussion was multifaceted, owing to the patient's lack of capacity, and input from multiple teams and the patient's relatives was required. Both ethical and clinical challenges arise from this case of a thromboembolic shower. |
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MeSH term(s) | Amputation, Surgical ; Arterial Occlusive Diseases/diagnostic imaging ; Arterial Occlusive Diseases/therapy ; Biomarkers/blood ; Cerebral Infarction/diagnostic imaging ; Cerebral Infarction/therapy ; Computed Tomography Angiography ; Coronary Thrombosis/diagnostic imaging ; Coronary Thrombosis/therapy ; Diagnosis, Differential ; Echocardiography ; Electrocardiography ; Humans ; Male ; Mesenteric Ischemia/diagnostic imaging ; Mesenteric Ischemia/therapy ; Middle Aged ; Pulmonary Embolism/diagnostic imaging ; Pulmonary Embolism/therapy ; Splenic Infarction/diagnostic imaging ; Splenic Infarction/therapy ; Thromboembolism/diagnostic imaging ; Thromboembolism/therapy |
Chemical Substances | Biomarkers |
Language | English |
Publishing date | 2021-02-09 |
Publishing country | England |
Document type | Case Reports ; Journal Article |
ISSN | 1757-790X |
ISSN (online) | 1757-790X |
DOI | 10.1136/bcr-2020-238580 |
Database | MEDical Literature Analysis and Retrieval System OnLINE |
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