Aortic arch thrombus caused by nitrous oxide abuse.

Area of Science:

• Cardiology
• Neurology
• Toxicology

Background:

• Recreational nitrous oxide (N2O) use is increasing, often perceived as low-risk.
• Emerging evidence suggests potential adverse health effects associated with N2O abuse.
• Thromboembolic events are serious vascular complications requiring thorough investigation.

Observation:

• A patient presented with a major aortic arch thrombus, leading to arterial occlusion of the arm.
• The patient also experienced temporary cerebral infarction.
• Subsequently, deep venous thrombosis and pulmonary embolism were diagnosed.

Findings:

• No conventional risk factors for thrombosis were identified in this high-flow arterial system.
• The patient had a history of chronic nitrous oxide abuse.
• Laboratory tests supported the hypothesis linking N2O abuse to the thrombus formation, a previously undescribed complication.

Implications:

• This case highlights a potential novel risk of chronic nitrous oxide abuse: severe thromboembolic disease.
• Further research is warranted to elucidate the mechanism by which N2O may induce thrombosis.
• Clinicians should consider N2O abuse in the differential diagnosis for unexplained thromboembolic events, particularly in young, otherwise healthy individuals.