CTICasesConcurrent Venous, Pulmonary Arterial, and Aortic Thrombus (Hypercoagulable State)
Imaging findings
CT of the chest and abdomen demonstrates simultaneous thrombus in the inferior vena cava (with an IVC filter), superior mesenteric artery, and an eccentric adherent intraluminal clot in the descending thoracic aorta, in addition to bilateral pulmonary emboli in the left pulmonary artery.
Key takeaways
Simultaneous multi-territory thrombosis involving both arterial and venous systems is highly suggestive of an underlying hypercoagulable state. The presence of both arterial thrombus (adherent aortic clot, superior mesenteric artery thrombosis) and venous thrombus (IVC, pulmonary emboli) in a young patient without a patent foramen ovale strongly raises the possibility of a primary thrombophilia (e.g. Factor V Leiden, antiphospholipid syndrome).
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