Medical management of a large aortic thrombus in a young woman with essential thrombocythemia.
Aortic thrombus formation is rare in the patients with essential thrombocytosis (ET); therefore, no guidelines for its management have been established. Embolism from ET-associated large vessel thrombi is potentially lethal and has been managed surgically in a few reported cases. We describe herein a 45-year-old black woman with ET found to have a 3.5-cm, pedunculated intra-aortic thrombus at the thoracoabdominal junction. How to treat this potentially devastating aortic thrombus was a management dilemma. We believed, based on the patient's diagnosis of ET and the histology of similar thrombi in 1 reported series, that the aortic thrombus was a "white thrombus" consisting primarily of aggregated platelets with a minimal fibrin network and almost no entrapped erythrocytes. The patient was treated with aspirin, 325 mg daily, as a platelet antiaggregating agent and hydroxyurea, 1,500 mg daily, to reduce the platelet count to less than 450 x 10(9)/L. The thrombus resolved without severe thromboembolic events. To our knowledge, this is the first reported case of a large intra-aortic thrombosis associated with ET that has been successfully managed with medical therapy alone.
Fang
M
M
Department of Medicine, Norwalk Hospital, Yale University School of Medicine, Conn, USA. mingfang_98@yahoo.com
Agha
S
S
Lockridge
L
L
Lee
R
R
Cleary
J P
JP
Mazur
E M
EM
D001012:Aorta, Abdominal; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D001241:Aspirin / Q000627:therapeutic use*; D001707:Biopsy, Needle; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006918:Hydroxyurea / Q000008:administration & dosage*; D008875:Middle Aged; D012720:Severity of Illness Index; D013922:Thrombocytosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D001241:Aspirin; D006918:Hydroxyurea