Lymphoma of prosthetic aortic graft presenting as recurrent embolization

We describe the case of a patient who presented with transient ischemic attack 4 years after bicuspid aortic valve repair, ascending aorta, and hemiarch replacement. Workup included cross-sectional imaging consistent with thrombus in the ascending aorta graft. Warfarin was initiated, but another episode of cerebral ischemia occurred despite therapeutic anticoagulation. Surgery was performed to avoid further embolization as re-replacement with a homograft aorta. Histologic analysis of the material found within the graft demonstrated large B cell lymphoma. At 39 months' follow-up, there have been no additional episodes of embolization and no evidence of recurrent cancer.