Left Carotid Artery Thrombosis due to Thromboangiitis Obliterans
BACKGROUND/INTRODUCTION: Thromboangiitis obliterans (TAO, Buerger’s Disease) is a rare, segmental, non-atherosclerotic vasculitis that causes thrombosis and occlusion of the small and medium sized vessels of the distal extremities. However, it can, in rare cases, affect vessels in the gastrointestinal, cerebrovascular, coronary, and renal systems. The etiology of TAO is unknown, but there is a strong association with smoking in the development and the progression of the disease. The purpose of this study is to discuss diagnosis and complications of thromboangiitis obliterans, including a rare manifestation of the disease found in a 42-year-old woman with TAO. CASE REPORT: A 42-year-old homeless Caucasian female was found dead, outdoors, near her campsite. Records show she was assaulted five days prior and she sustained a broken nose and a concussion from that incident. Her medical history was significant for a post-traumatic seizure disorder related to a closed head injury that occurred over two decades prior to death, alcoholism, Buerger’s disease, hypertension, COPD, hepatitis C and remote breast cancer. Although initial investigation suggested that the death might be related to trauma, autopsy revealed no significant trauma. However, the autopsy did reveal a thrombus occluding her left carotid artery. Microscopic examination revealed multifocal areas of acute inflammation within vessel walls as well as atherosclerosis and intraluminal thrombosis. Corresponding brain tissue showed softening of the area supplied by the left internal carotid artery, which microscopically was determined to be due to acute ischemic necrosis. In addition, examination of the lungs was consistent with COPD. It was concluded that thromboangiitis obliterans, likely precipitated by smoking, was the cause of the thrombus, and thus her cause of death. DISCUSSION/CONCLUSION: Thromboangiitis obliterans, though a relatively rare disease, can cause significant complications, including ulceration, gangrene and life threatening thrombosis. Proper diagnosis, though hindered by conflicting diagnostic criteria, is the first step in preventing these complications. As the present case reveals, manifestations beyond the extremity vessels can be life-threatening, so it is important that physicians be aware of these possible complications when treating patients with TAO.