Lisette van Dam

MRDTI in abdominal aortic thrombosis 9 147 INTRODUCTION Aortic intraluminal thrombosis (ILT) commonly occurs in the presence of aortic pathology, such as aneurysmal disease, atherosclerotic plaque and/or dissection. Approximately 70-80% of patients with an abdominal aortic aneurysm (AAA) develop a non-occlusive aortic ILT. 1 Accurate diagnosis and treatment of ILT are of utmost importance to prevent serious complications such as (peripheral) arterial embolic occlusion with resultant ischemia. 2 To the best of our knowledge, we present the first report of a patient in whom the non-invasive magnetic resonance direct thrombus imaging (MRDTI) technique was used to determine whether an abdominal aortic thrombus was acute or chronic to guide antithrombotic management. CASE DESCRIPTION A 43-year-old man was referred to our hospital with abdominal discomfort for several months. He was a heavy smoker with 30 pack/years. His medical history included an ischemic stroke, helicobacter pylori gastritis and severe hypertension complicated by cardiac hypertrophy. He was prescribed chlorthalidone, barnidipine, lisinopril, nebivolol, clopidogrel, simvastatin and ranitidine. His family history was remarkable for multiple aortic aneurysms and coronary artery disease in his father, who died at a young age of a ruptured aneurysm. His mother had been treated for systemic hypertension. On physical examination he was hypertensive with a blood pressure of 211/130 mmHg and a heart rate of 55 bpm. During auscultation of the abdomen a murmur was recognized. Palpitation of the abdomen was not painful. Peripheral pulsations were present in both arms and legs. Neurologic examination was normal. Laboratory results showed severe renal insufficiency with an estimated glomerular filtration rate (eGRF) of 14mL/min and a creatinine level of 418 µmol/L. A CT angiography was performed showing a large suprarenal aortic aneurysm with diffuse circular atherosclerosis and extensive circumferential aortic wall thrombosis ( Figure 1A and 1B ). The celiac trunk, superior mesenteric artery and right renal artery were occluded with an atrophic right kidney. The left renal artery was critically stenosed. The patient was subjected to PTA of the left renal artery, which was complicated by complete occlusion. To rescue the left kidney