Aortic Bifurcation Saddle Thrombus

Acute aortic pathology demands a high index of suspicion and frequent reevaluations during emergency department (ED) stay for proper diagnosis. This high index of suspicion is crucial to avoid missing the potentially devastating aortic diagnosis. Here, we present a 59-year-old male who presented with chest pain and was ultimately diagnosed with a rare aortic bifurcation saddle thrombus causing acute aortic occlusion. This diagnosis, although rare, highlights a more common point that all patients should be reevaluated for an acute aorta, especially when diagnostic clues are present. The diagnosis was found only because of a thorough reevaluation. Missing the diagnosis would have resulted in death or lifetime dependence on hemodialysis.