Ascending Aortic Thrombus With Peripheral Embolization.

Area of Science:

• Cardiovascular Medicine
• Vascular Surgery
• Diagnostic Imaging

Background:

• Thoracic aortic mural thrombi are uncommon, particularly in healthy aortas without aneurysms or atherosclerosis.
• These thrombi most frequently occur in the descending aorta but can also be found in the aortic arch, abdominal aorta, and ascending aorta.
• Arterial embolization is the primary clinical manifestation of aortic mural thrombi, despite their rarity.

Observation:

• A 48-year-old male patient presented with acute arterial ischemia in the right upper limb.
• No significant cardiovascular risk factors or history of trauma were noted in the patient.
• Initial investigations revealed an unstable, pedunculated mass in the distal ascending aorta.

Findings:

• The mass in the ascending aorta was identified as a thoracic aortic mural thrombus.
• The thrombus was deemed the source of peripheral embolization leading to limb ischemia.
• Urgent surgical intervention was performed due to the high risk of further embolization.

Implications:

• This case underscores the importance of considering the aorta as a potential source of peripheral emboli, even in the absence of aneurysmal or significant atherosclerotic disease.
• Prompt diagnosis and surgical management, including thrombus excision and aortic repair, are crucial for preventing further embolic events.
• Etiological evaluation for underlying prothrombotic conditions is essential in managing aortic mural thrombi.