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Digital embolization from plaque-related thrombus in the thoracic aorta: identification with transesophageal
J L Blackshear1, A Jahangir, W A Oldenburg
1Division of Cardiovascular Diseases, Mayo Clinic Jacksonville, FL 32224.
Insights
A large aortic thrombus caused painful blue toes in a patient. Anticoagulant therapy successfully dissolved the mass, resolving symptoms and preventing further peripheral embolization.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Peripheral embolization can cause significant morbidity.
- Aortic thrombus is a potential source of systemic emboli.
Observation:
- A 71-year-old man presented with painful blue toes following prolonged vomiting.
- Transesophageal echocardiography revealed a large mobile mass in the descending thoracic aorta, suggestive of thrombus.
Findings:
- Anticoagulant therapy with heparin and warfarin was initiated without further diagnostic evaluation.
- Follow-up transesophageal echocardiography showed significant resolution of the aortic mass after three months.
- Complete resolution of toe pain and discoloration was observed.
Implications:
- This case highlights the effectiveness of anticoagulant therapy in managing aortic thrombus-related peripheral embolization.
- Prompt diagnosis and treatment can prevent limb-threatening ischemia.
- Non-invasive imaging plays a crucial role in identifying the source of emboli.
Abstract:
A 71-year-old man had painful blue toes after an episode of protracted vomiting. Abdominal, cardiac, and transesophageal ultrasound studies were performed before angiography was considered. A large mobile mass in the proximal descending thoracic aorta, which suggested thrombus, was identified by transesophageal echocardiography. With no further evaluation, anticoagulant therapy with heparin and warfarin was initiated. Three months later, repeated transesophageal echocardiography demonstrated only a tiny vestige of the plaque-related mass. The pain and discoloration of the toes resolved completely. The advantages and disadvantages of the various diagnostic and therapeutic approaches to peripheral embolization are discussed.