Aorta thrombosis diagnosed due to acute myocardial infarct

A 54-year-old man was admitted for acute weakness in both legs. His past medical history was limited to a likely lower limb arteriopathy. His cardiovascular risk factors were heavy smoking habit and hypertension. The electrocardiogram was typical of inferior semi-recent myocardial infarct, with a Q-wave and ST-segment elevation. Transthoracic echocardiography showed an inferior hypokinesia, low left ventricular ejection fraction evaluated to 40%, normal valves, normal right cavities. An aortic computed tomography scan was then performed to rule out aortic dissection, or other aortic disorders. This scan showed an aortic thrombosis, just after the ostia of the renal arteries. Arteries were calcified, supporting the arteriopathy. This confirmed the total occlusion of the right coronary artery, without any other significant lesions. Ventricular angiography confirmed the inferior hypokinesia. The patient then suffered from an asymptomatic inferior acute myocardial infarct leading to acute aortic thrombosis, because of likely low outflow acutely worsening severe lower limb arteriopathy. The clinical presentation was surprising, as the patient had never complained of any strong pain, neither chest pain, nor lower limb pain.