Floating thrombus in the proximal aortic arch

Abstract

Floating thrombus in the aortic arch is an unusual source of systemic embolism. Surgical removal of the thrombus is a therapeutic option, because thrombolytic therapy carries the risk of partial lysis and repeat embolization. We report a case involving a large floating thrombus that originated in the proximal aortic arch and extended into the left subclavian artery and the descending aorta, and we discuss the surgical management.

Fig. 1 Transesophageal echocardiographic images of a long, floating thrombus (T) in the aortic arch. The stalk can be seen in the proximal aortic arch (A), and the floating end can be seen in the distal aortic arch and the descending aorta (B). The adjacent aortic wall was thickened with diffuse atherosclerosis and focal calcific plaque.

Fig. 2 Computed tomographic images of the floating thrombus A) in the aortic arch (black arrowhead) and B) in the left subclavian artery (white arrowhead).

Fig. 3 Organized thrombus. The base of the thrombus (b), the arm that extended into the left subclavian artery (s), and the end that floated within the descending aorta (d) are shown.