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We describe a case of a 76-year-old woman who presented to the Emergency Department with right lower limb pain after a fall. One hour after the admission to the Emergency Department, the patient presented all the signs and symptoms of acute limb ischemia. The patient underwent contrast-enhanced computed tomographic scan of abdomen and right lower limb that showed a large abdominal lesion suggestive of ovarian cancer compressing the right common iliac artery and a visible thrombus and ruptured plaque in this artery. We hypothesized that the acute limb ischemia caused by thrombosis in situ arose from acute plaque rupture probably due to the impact of the large abdominal mass on the artery during patient’s fall.