Diffuse Arterial Thrombosis as a First Manifestation of Occult Malignancy.

Aim. To raise the awareness of a hypercoagulability state as it is often associated with the different types of malignancies. Venous thromboembolism is a frequent complication in these patients, and usually it happens after the diagnosis of cancer is confirmed. However, hypercoagulability disorders presenting as the first symptoms or signs in the cancer patients have rarely been reported. Furthermore, arterial thrombosis is extremely rare even in cancer patients. Method. Review of the case characteristics and literature review. Results. We present a case of 39-year-old woman who was admitted to our hospital because of intermittent claudication in the right lower extremity. CT angiography revealed multiple thrombi in the arterial system starting from the left ventricle, followed by a thrombus in the distal part of the descending aorta, in the superior mesenteric artery, and in the right popliteal artery. Further investigation of this young patient with no risk factors for hypercoagulable state and no other comorbidities led to complete work-up including diagnostic evaluation for malignancy. The suspicion was confirmed after performing upper endoscopy with biopsy, which revealed malignant neoplasm of the stomach. Conclusion. Whenever a patient suffers hypercoagulability disorders, even arterial thrombosis, we should always consider the possibility of a cancer.

Antiphospholipid Syndrome - A Case Report of Pulmonary Thromboembolism, Followed with Acute Myocardial Infarction in Patient with Systemic Sclerosis.

AIM: We are presenting an uncommon case of pulmonary embolism, followed with an acute myocardial infarction, in a patient with progressive systemic sclerosis. CASE PRESENTATION: A female 40 years of age was admitted with signs of pulmonary embolism, confirmed with CT scan, which also reviled a thrombus in the right ventricle. The patient had medical history of systemic sclerosis since the age of 16 years. She suffered an ischemic stroke 6 years ago, but she was not taking any anticoagulant or antithrombotic medications ever since. She received a treatment with thrombolytic therapy, and subsequent UFH, but, on the second day after receiving fibrinolysis, she felt chest pain accompanied with ECG changes consistent for ST-segment elevation myocardial infarction (STEMI). Urgent coronary angiography was undertaken, which reviled cloths causing total occlusion in 4 blood vessels, followed with thromboaspiration, but without successful reperfusion. Several hours later the patient developed rapid deterioration with letal ending. During the very short hospital course, blood sampling reviled presence of antiphospholipid antibodies. CONCLUSION: The acquired antiphospholipid syndrome is common condition in patients with systemic autoimmune diseases, but relatively rare in patients with systemic sclerosis. Never the less, we have to be aware of it when treating the patients with systemic sclerosis.