Isolated Thoracic Aortic Takayasu Arteritis Presenting as Presumed Mobile Aortic Thrombus

Isolated aortic mural thrombus (AMT) is an infrequent occurrence in the setting of an otherwise normal aorta and is a similarly rare occurrence in Takayasu arteritis (TAK). As such, consensus on optimal treatment strategy does not exist, however, invariably necessitates anticoagulation. We report a case of a 21-year-old female who presented with acute chest pain with an isolated descending thoracic AMT on imaging. Diagnosis was elusive after an exhaustive, multidisciplinary evaluation including structural, hypercoagulable, and rheumatologic etiologies. After hypertension control and anticoagulation, she was asymptomatic without embolic sequelae. We proceeded with thoracic aortic resection with interposition reconstruction for the dual function of treatment and definitive diagnosis revealing TAK. This demonstrates a curious presentation of TAK with an equally atypical complication managed with surgery.