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Multiorgan thromboembolic shower and its ethical implications
  1. Amedra Basgaran,
  2. Sayani Khara and
  3. Aravinth Sivagnanaratnam
  1. Stroke Medicine, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
  1. Correspondence to Dr Amedra Basgaran; a.basgaran{at}


A 54 year-old man was admitted after being found on the floor of his home, thought to have been there for approximately 5 days. He was diagnosed with a non-ST elevation myocardial infarction and bilateral cerebral ischaemic infarcts, as well as an acute kidney injury driven by rhabdomyolysis. The following day, bilateral lower limb ischaemia was observed. A full body CT angiogram revealed a complete thromboembolic shower with bilateral arterial occlusion in the lower limbs, bilateral pulmonary emboli, a splenic infarct and mesenteric ischaemia. An echocardiogram revealed a large thrombus in the left ventricle as the likely thromboembolic source. Bilateral lower limb amputations were recommended, commencing a complex discussion regarding the best course of management for this patient. The discussion was multifaceted, owing to the patient’s lack of capacity, and input from multiple teams and the patient’s relatives was required. Both ethical and clinical challenges arise from this case of a thromboembolic shower.

  • ethics
  • ischaemic heart disease
  • venous thromboembolism
  • stroke

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  • Contributors AB and SK contributed to writing the article. AS contributed to editing the article. AS and AB identified and managed the case.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.