Acute abdominal aortic thrombosis is a rare but potentially fatal condition. The patient was a 56-year-old man who developed lower back pain and arrived at our emergency room in a state of shock. He was alert, but could not move his legs. Cardiac echo revealed abnormal movement of the heart, and acute myocardial ischaemia was suspected as a differential diagnosis. Emergency coronary angiography and aortography together with percutaneous cardiopulmonary support were attempted. Both femoral arteries were punctured, but the guide wire could not be advanced from the bifurcation to the aorta. Heart stoppage occurred and life saving treatment was in effective. A large thrombus from the abdominal aorta to both common iliac arteries was observed by aortography. To reduce mortality in acute abdominal aortic thrombosis, the disease must be recognised early based on clinical symptoms, followed by immediate contrast CT and surgical management by thrombectomy or re-establishment of the blood circulation.
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