Recurrent embolism caused by floating thrombus in the thoracic aorta

A case of embolic recurrent episodes resulting in acute lower-limb ischemia from an unusual source is reported. This occurred in a patient on steroids for rheumatoid arthritis. Femoropopliteal thromboembolectomy successfully restored arterial flow. Diagnostic evaluation for identifying the source of embolism revealed a large, pedunculated and mobile thrombus arising from a nonaneurysmatic and nonatherosclerotic descending thoracic aorta. The thrombus was identified by transesophageal echocardiography and was successfully removed by aortic thromboendarterectomy. We emphasize the importance of transesophageal echocardiography as a reliable method for the diagnosis of thoracic aorta diseases and for identification of aortic thrombi. An aggressive surgical approach is recommended in the low-risk patient to prevent further embolic episodes.