Neonatal aortic thrombosis

Case contributed by Dr Khalid Alhusseiny

Presentation

Preterm baby admitted in neonatal ICU (NICU), presented with hypertension on day 11 of life.

Patient Data

Age: 11 days
Gender: Female
Ultrasound

Color Doppler evaluation of both kidneys revealed markedly reduced vascularity of the right kidney when compared to the left side. The arterial flow at the right renal hilum shows reduced peak systolic and end diastolic velocities with increased resistivity index. An echogenic partly non-adherent / floating thrombus is seen inside the aorta at the origin of the right renal artery.

Well-defined irregular-shape hypoechoic lesion is seen at the right lobe of the liver with internal echogenic gas foci keeping with hepatic abscess.

Ultrasound

Annotated images showing an echogenic partly non-adherent / floating thrombus inside the aorta at the origin of the right renal artery.

CT

Extensive thrombosis of the descending thoracic aorta with partial thrombosis of the abdominal aorta at the origin of the right renal artery.

Gas density seen at the right lobe of the liver confirming the presence of hepatic abscess.

Bilateral pulmonary opacities are demonstrated, more at the bases.

Case Discussion

This was a female baby preterm 31 weeks, delivered by urgent cesarean section due to severe preeclampsia. She was admitted to NICU as she developed respiratory distress immediately after delivery. The baby had umbilical venous and arterial catheters placed on day one of admission and kept in place for 2 days. On day 11 of admission, her routine laboratory and clinical work-up revealed septicemia and hypertension, for which abdomen ultrasound and renal Doppler evaluation were requested. Sonography revealed hypoperfusion of the right kidney with aortic thrombus compromising the renal artery, and a hepatic abscess. Contrast enhanced CT confirmed the sonographic findings and revealed extensive thrombosis of the descending thoracic aorta.

Unfortunately; the baby died one day later.

Neonatal aortic thrombosis is a rare life-threatening condition mostly occurs secondary to umbilical arterial catheter among other causes such as prematurity, sepsis, maternal diabetes and dehydration. Treatment options may include anticoagulation, thrombolysis and thrombectomy.

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