Ovarian mass causing paradoxical MI and leg ischaemia

Area of Science:

• Cardiology
• Oncology
• Vascular Surgery

Background:

• Paradoxical emboli through a patent foramen ovale can cause stroke, limb ischemia, and myocardial infarction (MI).
• Embolization to coronary arteries is a known, though uncommon, consequence of paradoxical emboli.
• Acute MI, cardiogenic shock, and cardiac arrest typically have different etiological considerations.

Purpose of the Study:

• To present an unusual case of acute MI, cardiogenic shock, and cardiac arrest.
• To highlight a novel mechanism of coronary artery occlusion and subsequent lower limb ischemia.
• To emphasize the importance of considering pelvic malignancy as a source of thromboembolism.

Main Methods:

• Case report detailing a patient presenting with acute MI, cardiogenic shock, and cardiac arrest.
• Percutaneous coronary intervention (PCI) was performed for left main stem (LMS) occlusion.
• Abdominal and pelvic CT scan to identify the source of emboli.
• Bilateral groin exploration and thromboembolectomy for lower limb ischemia.

Main Results:

• Thrombotic material embolized to the aortic root, causing transient LMS occlusion and acute MI.
• The thrombus subsequently lodged at the aortic bifurcation, causing lower limb ischemia.
• CT scan revealed an undiagnosed ovarian malignancy with metastatic spread as the source of the thrombus.
• The patient experienced cardiogenic shock and cardiac arrest due to the acute MI.

Conclusions:

• This case demonstrates an extremely rare cause of acute MI and cardiogenic shock originating from pelvic venous thrombosis due to ovarian malignancy.
• It underscores the necessity of considering unusual sources of emboli, including malignancy-associated thrombosis, in the differential diagnosis of anterolateral MI.
• The presented imaging findings of embolization to the aortic root and LMS are previously unreported.