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Case Reports
. 2022 Dec 5;14(12):e32212.
doi: 10.7759/cureus.32212. eCollection 2022 Dec.

A Ticking Time Bomb: A Case of Floating Distal Aortic Arch Intraluminal Thrombus

Mohamed Ghoweba  1 , Jason Gnasigamany  1 , Madhu Chiluveri  1 , John McClish  2
Affiliations
Case Reports

A Ticking Time Bomb: A Case of Floating Distal Aortic Arch Intraluminal Thrombus

Mohamed Ghoweba et al. Cureus. .

Abstract

Aortic arch thrombus is a rare entity that can result in catastrophic sequelae. This is a case report of a 65-year-old female patient who presented with chest pain that started one day prior to arrival at the emergency department. Acute coronary syndrome (ACS) and pulmonary embolism (PE) were ruled out. A filling defect at the distal aortic arch evident on chest computed tomography angiography (CTA) was confirmed to be a floating distal aortic arch thrombus on transesophageal echocardiogram (TEE). There was no evidence of an underlying aneurysm, dissection, or significant atherosclerosis. The patient was considered to be at high risk for surgical intervention, hence, a decision was made to start the patient on chronic anticoagulation with direct oral anticoagulants (DOACs). A follow-up CTA three months later showed total resolution of the thrombus. The report highlights this treacherous pathology and provides an overview of the predisposing factors, radiologic findings, as well as management strategies for floating aortic arch thrombi.

Keywords: aortic arch thrombus; arterial thrombosis; intraluminal thrombus; mural arch thrombus; mural thrombus.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. CTA/Aortogram showing a non-occlusive distal aortic arch filling defect (arrowhead).
CTA: computed tomography angiogram
Figure 2
Figure 2. Follow-up CTA/aortogram three months following discharge showing total resolution of aortic arch thrombus.
CTA: computed tomography angiogram
See this image and copyright information in PMC

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