Large Mobile Ascending Aortic Atheroma Presenting With Systemic Embolization: Surgical Resection

Mobile ascending aortic atheromas are rare but carry high embolic risk, including ischemic stroke and peripheral embolization. Early recognition is crucial to prevent severe cardiovascular complications.

A 63-year-old woman with hypertension and hypothyroidism presented with abdominal pain, nausea, and vomiting. Computed tomography angiography revealed multiple splenic infarcts and a soft tissue mass in the ascending aorta, initially concerning for localized dissection. Transesophageal echocardiography confirmed a large, mobile atheroma. Given its size, mobility, and embolic events, surgical resection with prophylactic left atrial appendage occlusion was performed.

Mobile ascending aortic atheromas, especially with embolization, carry high morbidity. Multimodal imaging is key for diagnosis and risk stratification. Although anticoagulation may suffice for stable lesions, surgery is warranted in high-risk cases.

Suspicion for aortic atheroma should be maintained in unexplained embolic events. Transesophageal echocardiography is essential for diagnosis, and early surgery may be lifesaving in high-risk patients.