Aortic Mural Thrombus in the Non-atherosclerotic Aorta of Patients with Multiple Hypercoagulable Factors

Abstract

An aortic mural thrombus (AMT) on a non-atherosclerotic wall is a rare but important cause of arterial thromboembolism. We herein report two cases of AMT in the thoracic aorta. Both showed multiple hypercoagulable factors (case 1: protein S deficiency and positive finding of anti-cardiolipin antibody; case 2: protein C deficiency, gastric cancer, and cisplatin-based chemotherapy) and were successfully treated with anticoagulation. Hypercoagulable states, including malignancy, can influence the formation of AMT; therefore, the accurate assessment of a hypercoagulable condition is necessary when we encounter patients with AMT.

Keywords: anticoagulant therapy; aortic thrombus; arterial embolism; hypercoagulable disorder.

Figure 1.

Imaging findings of a 50-year-old man with sudden dysarthria and right-hand paralysis (Case 1). On admission, brain magnetic resonance imaging showed acute left cerebellar infarction on diffusion-weighted imaging (A, arrow). Contrast-enhanced computed tomography revealed an occluded right subclavian artery (B, arrow) and low-density lesion on the non-atherosclerotic aorta (C, arrow). Two weeks after anticoagulant therapy, the aortic lesion had disappeared (D).

Figure 2.

Imaging findings of a 70-year-old man with gastric cancer receiving cisplatin-based chemotherapy (Case 2). A low-density lesion on the aorta that had not been detected on previous imaging tests was noted on contrast-enhanced computed tomography after a course of chemotherapy (A, arrow). The lesion disappeared two months after anticoagulant therapy (B).