Korean J Crit Care Med.  2015 Aug;30(3):227-230. 10.4266/kjccm.2015.30.3.227.

Unexpected Multiple Organ Infarctions in a Poisoned Patient

• Park SW
• Han SK
• Yeom SR
• Park SC
• Lee SH

• KMID: 2227655
• DOI: http://doi.org/10.4266/kjccm.2015.30.3.227

Abstract

Predisposing factors for venous thrombosis can be identified in the majority of patients with established venous thromboembolism (VTE). However, an obvious precipitant may not be identified during the initial evaluation of such patients. In the present case, a 47-year-old female presented to the emergency department of our hospital after ingesting multiple drugs. She had no VTE-related risk factors or previous episodes, nor any family history of VTE. After admission to the intensive care unit sudden hypoxemia developed, and during the evaluation cerebral, renal, and splenic infarctions with pulmonary embolisms were diagnosed. However, the sources of the emboli could not be identified by transthoracic echocardiography or computed tomography angiography. Protein C deficiency was identified several days later. We recommend that hypercoagulable states be taken into consideration, especially when unexplained thromboembolic events develop in multiple or unusual venous sites.

Keyword

infarction; thrombophilia; venous thromboembolism

MeSH Terms

Angiography
Anoxia
Causality
Echocardiography
Emergency Service, Hospital
Female
Humans
Infarction*
Intensive Care Units
Middle Aged
Protein C Deficiency
Pulmonary Embolism
Risk Factors
Splenic Infarction
Thrombophilia
Venous Thromboembolism
Venous Thrombosis

Figure

• 

  Fig. 1. Computed tomography (CT) of head and CT angiography. (A) Pulmonary emboli in right main and lower left lobar artery (arrows). (B) Left kidney and splenic infarctions. (C) Right kidney infarction. (D) Large low-density and sulcal effacement in middle left cerebral artery territory indicating acute infarction. Left lateral ventricle effacement and slight midline shift is also shown.

Reference

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