Calcified left ventricular aneurysm: Delayed thrombus formation leading to multiorgan thrombosis

After a myocardial infarction, left ventricular aneurysms (LVAs) can form thrombus within the aneurysmal sac, which can then embolize and cause multi-organ thrombosis. This case demonstrates a rare occurrence of delayed thrombus formation in a calcified LVA, emphasizing the importance of prompt diagnosis and management. A 55-year-old male from rural Somalia arrived with severe abdominal pain and confusion. He had no chest pain and no relevant medical history. The examination revealed bilateral leg edema and a grade 4 systolic murmur. Laboratory results indicated elevated WBC (34 × 10⁹/L) and CRP (200 mg/L), while cardiac biomarkers were negative. ECG revealed a prior myocardial infarction with persistent ST-segment elevation. Echocardiography revealed a large apical LVA with a mural thrombus and a reduced ejection fraction (35%). CT scans confirmed the calcified aneurysm and revealed thrombi in the superior mesenteric artery, mesenteric vein, splenic vein, and portal vein. The patient's thrombus embolization from a calcified LVA caused multi-organ thrombosis, which was successfully treated with anticoagulation medication. The patient's response to conservative treatment and stable clinical progression prevented the need for surgery. This case emphasizes the value of anticoagulation in preventing additional complications and the significance of comprehensive imaging in diagnosing thromboembolic events. In settings with limited resources, a comprehensive diagnostic approach that includes CT imaging and echocardiography is crucial to determining the underlying causes of multiorgan thrombosis. When treating thromboembolic complications brought on by a calcified LVA, anticoagulation is important.