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Obscure Severe Infrarenal Aortoiliac Stenosis With Severe Transient Lactic Acidosis.

Nantsupawat T, Mankongpaisarnrung C, Soontrapa S, Limsuwat C, Nugent K - J Investig Med High Impact Case Rep (2013)

Bottom Line: The patient was subsequently extubated and was alert and oriented with no complaints of leg or abdominal pain.Emergent computed tomography of the aorta confirmed infrarenal aortoiliac thrombosis.When in doubt, vascular studies should be implemented without delay to identify this catastrophic diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Texas Tech University Health Sciences Center, Lubbock, TX, USA.

ABSTRACT
A 57-year-old man presented with sudden onset of leg pain, right-sided weakness, aphasia, confusion, drooling, and severe lactic acidosis (15 mmol/L). He had normal peripheral pulses and demonstrated no pain, pallor, poikilothermia, paresthesia, or paralysis. Empiric antibiotics, aspirin, full-dose enoxaparin, and intravenous fluid were initiated. Lactic acid level decreased to 2.5 mmol/L. The patient was subsequently extubated and was alert and oriented with no complaints of leg or abdominal pain. Unexpectedly, the patient developed cardiac arrest, rebound severe lactic acidosis (8.13 mmol/L), and signs of acute limb ischemia. Emergent computed tomography of the aorta confirmed infrarenal aortoiliac thrombosis. Transient leg pain and transient severe lactic acidosis can be unusual presentations of severe infrarenal aortoiliac stenosis. When in doubt, vascular studies should be implemented without delay to identify this catastrophic diagnosis.

No MeSH data available.


Related in: MedlinePlus

Livedo reticularis of left leg.
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fig2-2324709613479940: Livedo reticularis of left leg.

Mentions: His lactate levels decreased spontaneously from 15 mmol/L to 3.39, 2.52, and 1.28 mmol/L at 0, 10, 14, and 33 hours, respectively, after his initial symptoms, along with an improvement of arterial pH and anion gap (Figure 1). After 24 hours of admission, he improved dramatically and was extubated on day 2 of admission. Five hours after extubation (42 hours after admission), he started to have left leg pain. His left leg turned bluish and became paler with prominent livedo reticularis throughout his left leg (Figure 2). Therefore, a heparin drip was initiated promptly and vascular surgery was consulted. Soon after that, the patient developed sudden cardiac arrest with pulseless electrical activity. He had return of spontaneous circulation after 15 minutes of cardiopulmonary resuscitation. At that moment, his lactate level rebounded to 8.13 mmol/L. To rule out acute aortic dissection and acute massive pulmonary embolism as well as acute left limb gangrene from embolism, computed tomography of pulmonary artery with contrast and computed tomography angiogram of aorta were performed. He had no pulmonary emboli or abdominal aortic dissection. He did have high-grade stenosis of the infrarenal abdominal aorta just above the bifurcation, near total occlusion of the right common iliac artery, severe luminal narrowing of the left common iliac artery, bilateral external iliac arteries, and bilateral common femoral arteries by calcified and noncalcified plaques (Figures 3 and 4). Emergent revascularization was planned but the patient developed pulseless electrical activity/asystole again and passed away.


Obscure Severe Infrarenal Aortoiliac Stenosis With Severe Transient Lactic Acidosis.

Nantsupawat T, Mankongpaisarnrung C, Soontrapa S, Limsuwat C, Nugent K - J Investig Med High Impact Case Rep (2013)

Livedo reticularis of left leg.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC4528787&req=5

fig2-2324709613479940: Livedo reticularis of left leg.
Mentions: His lactate levels decreased spontaneously from 15 mmol/L to 3.39, 2.52, and 1.28 mmol/L at 0, 10, 14, and 33 hours, respectively, after his initial symptoms, along with an improvement of arterial pH and anion gap (Figure 1). After 24 hours of admission, he improved dramatically and was extubated on day 2 of admission. Five hours after extubation (42 hours after admission), he started to have left leg pain. His left leg turned bluish and became paler with prominent livedo reticularis throughout his left leg (Figure 2). Therefore, a heparin drip was initiated promptly and vascular surgery was consulted. Soon after that, the patient developed sudden cardiac arrest with pulseless electrical activity. He had return of spontaneous circulation after 15 minutes of cardiopulmonary resuscitation. At that moment, his lactate level rebounded to 8.13 mmol/L. To rule out acute aortic dissection and acute massive pulmonary embolism as well as acute left limb gangrene from embolism, computed tomography of pulmonary artery with contrast and computed tomography angiogram of aorta were performed. He had no pulmonary emboli or abdominal aortic dissection. He did have high-grade stenosis of the infrarenal abdominal aorta just above the bifurcation, near total occlusion of the right common iliac artery, severe luminal narrowing of the left common iliac artery, bilateral external iliac arteries, and bilateral common femoral arteries by calcified and noncalcified plaques (Figures 3 and 4). Emergent revascularization was planned but the patient developed pulseless electrical activity/asystole again and passed away.

Bottom Line: The patient was subsequently extubated and was alert and oriented with no complaints of leg or abdominal pain.Emergent computed tomography of the aorta confirmed infrarenal aortoiliac thrombosis.When in doubt, vascular studies should be implemented without delay to identify this catastrophic diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Texas Tech University Health Sciences Center, Lubbock, TX, USA.

ABSTRACT
A 57-year-old man presented with sudden onset of leg pain, right-sided weakness, aphasia, confusion, drooling, and severe lactic acidosis (15 mmol/L). He had normal peripheral pulses and demonstrated no pain, pallor, poikilothermia, paresthesia, or paralysis. Empiric antibiotics, aspirin, full-dose enoxaparin, and intravenous fluid were initiated. Lactic acid level decreased to 2.5 mmol/L. The patient was subsequently extubated and was alert and oriented with no complaints of leg or abdominal pain. Unexpectedly, the patient developed cardiac arrest, rebound severe lactic acidosis (8.13 mmol/L), and signs of acute limb ischemia. Emergent computed tomography of the aorta confirmed infrarenal aortoiliac thrombosis. Transient leg pain and transient severe lactic acidosis can be unusual presentations of severe infrarenal aortoiliac stenosis. When in doubt, vascular studies should be implemented without delay to identify this catastrophic diagnosis.

No MeSH data available.


Related in: MedlinePlus