AORTIC MURAL THROMBI ASSOCIATED WITH ULCERATIVE COLITIS

Abstract

A 47-year-old heavy smoker male was admitted with complaints of abdominal pain, frequent bloody stools (up to 12 per day), rectal bleeding, anorexia and signifi cant weight loss of 5 week-duration. A diffuse abdominal pain was noted on physical examination. Biological fi ndings revealed elevated C-reactive protein (22,8 mg/dl), mild leukocytosis (12630/mm3), severe microcytic anemia (7,5 g/dl) and hypoalbuminemia. Abdominal computed tomography demonstrated a left-sided infl ammatory colitis and aortic thrombi. Arterial thrombi were further characterized by aortic computed angiography revealing a large 5,4 cm-sized fl oating thrombus, adhering to a calcifi ed plaque at the level of thoraco-abdominal junction and a smaller one appended on the left side of aortic arch (fi gure 1). No peripheral embolization was found. At colonoscopy, macroscopic and microscopic fi ndings demonstrated an active ulcerative colitis. Thrombophilia screening was negative, the only abnormality of coagulation work-up being an elevated factor VIIIa. The patient gradually improved upon treatment with systemic glucocorticoids and mesalazine and anticoagulation with curative dose of low molecular weight heparin (nadroparin, 8000 anti-Xa IU, bid).