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01.12.2011 | Case report | Ausgabe 1/2011 Open Access

Journal of Medical Case Reports 1/2011

Multiple thromboembolism with multiple causes in a 69-year-old woman: a case report

Journal of Medical Case Reports > Ausgabe 1/2011
Luigi Iuliano, Maria Misuraca, Alessandro Varroni, Massimo Raponi, Marco Massucci, Alessandro Pagnanelli, Giuseppe Cimino, Giovanni Bertoletti
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1752-1947-5-186) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

LI interpreted the patient data regarding the multiple thrombosis and was a major contributor to the writing of the manuscript. MMis and AP collected the clinical data and reviewed the literature. MMis, AV, MMas, and GB were in charge of patient management for the surgical procedures. MR obtained and interpreted the echocardiographic studies. GC conducted JAK2 mutation analysis. All authors read and approved the final manuscript.



Aggressive, recurrent embolisms require accurate etiologic diagnosis. We describe the case of a 69-year-old Italian Caucasian woman with recurrent arterial embolisms in whom several sources and triggers of thrombosis were detected.

Case presentation

The patient, a 69-year-old Italian Caucasian woman, presented with a systemic embolism that was initially attributed to atrial fibrillation. The recurrence of embolisms despite anti-thrombotic therapy prompted a re-evaluation of the clinical presentation. New potential causes of thrombosis emerged in this patient, including thrombocytosis associated with the JAK2 V617F mutation and the very rare mural thrombosis of the descending aorta. A mural thrombus in the pulmonary artery was detected contiguous with the aortic mural thrombosis, raising the possibility of a clinically silent ductus Botalli as the initiating event. The patient was treated with warfarin, aspirin, hydroxyurea, and surgery.


The diagnosis was achieved via systematic use of imaging procedures and reconsideration of blood tests performed to explore the diagnosis of thrombosis. This allowed a deeper and more detailed analysis of the case beyond the conventional approach, which would have aimed to identify one cause for the condition at hand, in this case, atrial fibrillation. The broader approach that we used resulted in the diagnosis of multiple embolisms from multiple sites and multiple causes.

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