Aortic floating thrombus detected by computed tomography angiography incidentally: Five cases and a literature review

To analyze the findings of aortic floating thrombus (AFT) on computed tomography angiography (CTA) for a definitive, timely diagnosis and to select a reasonable management course to improve prognosis.

We retrospectively analyzed imaging findings of 5 patients with AFT detected by CTA, including location, morphology, size, involved aortic segment, concomitant embolism, stent, and dynamic changes during the follow-up.

Seven lesions were detected in the initial CTA studies of the 5 patients: 5 aortic intraluminal floating thrombi (3 patients) and 2 aortic in-stents floating thrombi (ASFTs; 2 patients). One aortic intraluminal floating thrombus was located in the right anterior wall of the ascending aorta and 2 in the aortic isthmus. Interval increasing in size of the splenic embolism and a new renal segmental artery embolism were noted in 1 patient after 7 days anticoagulation therapy. One ASFT was located in the original narrowing part of the aortic stent and another in the overlap of the stents. During the follow-up, some lesions disappeared, whereas the morphology and size varied in others. Four new ASFTs occurred. All the lesions were attached to the focal thickened inner walls of the stents with the free-floating portions along the direction of blood flow.

AFT is a rare, life-threatening disease. Abnormal coagulation function, aortic disease, and history of aortic stent implantation are the potential predictors for AFT. CTA scanning can depict the lesions clearly and evaluate curative efficacy. The therapeutic strategy should be based on the etiology and the patient's physical condition, whereas the preferred treatment is conservative medication.