A Devastating Floating Aortic Thrombus and Ketosis-Prone Diabetes

Abstract

This article reports a case study of a middle-aged patient diagnosed with Ketosis-Prone Diabetes (KPD) and diabetic ketoacidosis who had a mobile thrombus in the distal aortic arch with catastrophic complications from thrombus embolization. The pathogenesis of the mobile aortic thrombus is currently under investigation, with many risk factors having been found. Based on the patient's limited manifestation of atherosclerosis and the absence of any indications of thrombophilia, KPD and inflammation from uncontrolled hyperglycemia likely played a significant role in the formation of the thrombus. KPD is a subtype of diabetes characterized by the abrupt onset of severe hyperglycemia and ketoacidosis. The inflammation caused by uncontrolled hyperglycemia in KPD patients can lead to endothelial dysfunction and the activation of prothrombotic pathways. There is a lack of consensus regarding the optimal approach for managing a mobile aortic thrombus. The main strategies under consideration are conservative care, including anticoagulation alone, invasive removal of the thrombus, or endovascular intervention.

Keywords: aortic diseases; aortic thrombosis; diabetic keto acidosis; ketosis prone diabetes; systemic anticoagulation.

Figure 1. Transesophageal echocardiogram (TEE) confirms the presence of a markedly movable mass located in the distal region of the aortic arch.

Figure 2. CT scan showing a filling defect in the distal aortic arch (arrow).