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Incidental descending thoracic aortic thrombus: the conundrum of medical versus surgical therapy

Kay Khine1, Amit Toor1, Koroush Khalighi2

  • 1Department of Internal Medicine, Easton Hospital, Easton, PA, USA.

Journal of Community Hospital Internal Medicine Perspectives
|February 1, 2020
PubMed

Insights

A descending aortic thrombus can cause limb ischemia but may be successfully treated with anticoagulation. Early detection via imaging is crucial for preventing severe complications.

Area of Science:

  • Vascular Surgery
  • Cardiology
  • Radiology

Background:

  • Mural thrombus in the descending thoracic aorta is a significant cause of morbidity and mortality.
  • Early diagnosis of aortic thrombus is critical, as it is often detected post-organ damage.
  • Virchow's triad (hypercoagulability, stasis, endothelial injury) is the suspected mechanism for descending aortic thrombus formation.

Observation:

  • A 65-year-old female incidentally found to have a descending aortic thrombus on computed tomography (CT) scan.
  • The patient presented with no initial symptoms suggestive of aortic thrombus.

Findings:

  • The descending aortic thrombus was incidentally detected on a CT scan.
  • Successful treatment with anticoagulation was achieved.
  • No subsequent complications were observed in the patient.

Implications:

  • This case highlights the importance of considering aortic thrombus in cases of unexplained acute distal organ or limb ischemia.
  • Computed tomography is a valuable tool for incidental detection of descending aortic thrombus.
  • Anticoagulation can be an effective treatment strategy for descending aortic thrombus, preventing embolic events.

Keywords:
Complete blood profilecomputed tomographycongestive heart failureemergency departmentinterventional radiologytransesophageal echotransthoracic echo

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