Floating Thrombus in the Aortic Arch: Rare Images

Abstract

Aortic floating thrombus is a rare, life-threatening disease. Most cases of aortic thrombus are diagnosed after embolic events; however, on rare occasion we may diagnose this condition incidentally during routine examinations as in our case.

Keywords

floating thrombus - aortic arch - CTA

A 76 year-old patient, with a history of ischemic cardiomyopathy and chronic smoking, presented with bilateral lower limb white edema (typical of heart failure) with New York Heart Association stage II dyspnea evolving over a period of 3 days, all in a context of apyrexia and conservation of general condition.

On examination, we found a conscious patient with bilateral sibilant rales.

The laboratory results showed high levels of plasma D-Dimer at 418 ng/mL (normal range < 250 ng/mL).

Computed tomography angiography (CTA) demonstrated a filling defect suggestive of a thrombus in an otherwise healthy appearing aortic arch ([Fig. 1]).

Fig. 1 A chest computed tomography angiography shows a mass lesion (red arrow) measuring 10 × 9 mm in the aortic arch on axial section (A), sagittal section (B), and coronal section (C).

After careful consideration, conservative treatment using oral anticoagulation (low-molecular-weight heparin) was preferred as the first choice since the patient was considered unfit for open aortic arch surgery given his advanced age, unfortunately the patient died a day after initiation of anticoagulation.

Aortic floating thrombus is a rare, life-threatening disease.[1] Most cases of aortic thrombus are diagnosed after embolic events; however, occasionally we may diagnose this condition incidentally during routine examinations as in our case.[2] CTA identifies and localizes aortic thrombi and may disclose asymptomatic peripheral or visceral embolism.[3]

Conflict of Interest

None declared.

• References

• 1 Yang S, Yu J, Zeng W. et al. Aortic floating thrombus detected by computed tomography angiography incidentally: five cases and a literature review. J Thorac Cardiovasc Surg 2017; 153 (04) 791-803
• 2 Konstantinos T, Dimitrios K, Marianthi T, Nikolaos S, Ioannis L. Aortic arch floating thrombus complicated by distal embolization in a patient with malignancy. Case Rep Vasc Med 2018; 2018: 2040925
• 3 Wang B, Ma D, Cao D, Man X. Huge thrombus in the ascending aorta: a case report and literature review. J Cardiothorac Surg 2019; 14 (01) 157

Publication History

Received: 20 January 2023

Accepted: 07 February 2024

Article published online:
25 June 2024