A case of floating thrombus in the ascending aorta that caused recurrent peripheral arterial embolic events

Abstract

We report the case of a 62-year-old man with recurrent arterial embolisms to his arms caused by a thrombosis of the ascending aorta. He had developed a left brachial artery embolism 8 years previously, but presented with a right brachial artery embolus on this occasion. A clot-like mass was seen in the ascending aorta on computed tomography without significant atherosclerosis. Magnetic resonance imaging identified multiple asymptomatic cerebral infarctions. Therefore, we surgically removed the thrombus in the ascending aorta, which was an organized fibrin clot. Pathologically, atherosclerosis and plaque formation were evident at the intima where the clot attached. Clot formation was considered to be due to local arteriosclerosis. We report a case of thrombosis of the ascending aorta causing multiple and recurrent arterial embolisms. The patient had no evidence of coagulation disorders, and arteriosclerotic risk factors such as hypertension, diabetes mellitus, and dyslipidemia were absent. Thus, thrombosis may develop in patients without traditional risk factors. <Learning objective: We report a case of thrombosis of the ascending aorta causing multiple and recurrent arterial embolisms. The patient had no evidence of coagulation disorders, and arteriosclerotic risk factors such as hypertension, diabetes mellitus, and dyslipidemia were absent. Thus, thrombosis may develop in patients without traditional risk factors.>.

Keywords: Ascending aorta; Floating thrombus; Peripheral arterial emboli.

Fig. 1

(a) Contrast-enhanced computed tomography (CT) from 8 years before his current admission shows a mass in the arch aorta (arrow). (b) Twelve-lead electrocardiography on admission shows sinus rhythm. (c) Chest X-ray on admission revealed no abnormal findings. (d) Contrast-enhanced CT showed arterial obstruction from the right brachial artery to the proximal ulnar artery (arrow). (e) CT showing a clot-like mass in the ascending aorta (arrow). (f) Intraoperative echocardiography showing the mass in the ascending aorta (arrow).

Fig. 2

(a) Gross appearance of the 10 mm soft mass removed by aortotomy. The mass was divided during removal from the aortic wall. (b) Gross intraoperative findings showing the thickened wall of the ascending aorta (arrow) to which the mass was attached. (c) A histology image showing severe atherosclerosis and plaque formation (*).