A Case of Huge Thrombus in the Aortic Arch with Cerebrovascular Embolization

Abstract

Pedunculated thrombus in the aortic arch that is associated with cerebral infarction is very rare requires prompt diagnosis and treatment to prevent occurrence of another devastating complication. Transesophageal echocardiography is useful for detecting source of embolism including aortic thrombi. The treatment options of aortic thrombi involves anticoagulation, thrombolysis, thromboaspiration, and thrombectomy. Here we report a case of huge thrombus in the aortic arch, resulting in acute multifocal cerebellar embolic infarct in patient without any risk factors for vascular thrombosis. Thrombi in the aortic arch were diagnosed by transesophageal echocardiography and treated with anticoagulants successfully.

Successful Anticoagulation Therapy for Antiphospholipid Syndrome with Mobile Aortic Thrombi

“…TTE visualizes the aortic root and proximal ascending aorta; in some patients, it can demonstrate the aortic arch from suprasternal notch views. However, most echocardiographers advocate the use of TEE for the diagnosis of mobile thrombi within the heart or aorta [5]; TEE is more accurate than TTE as the probe is located closer to the aorta and can be used at a higher frequency [1, 3]. CT scanning is an alternative modality used to evaluate aortic thrombus; it can sometimes detect thrombi in areas that are not visualized by TEE [6].…”

“…The most common site of arterial thrombosis in APS is the central nervous system, with half of the cases resulting in strokes and transient ischemic attacks [2]. The major source of arterial systemic emboli is the heart, whereas systemic thrombi originating from the aorta are much less common [3]. We hereby report the case of successful anticoagulation management in an APS patient with mobile thrombi within the aorta.…”

Recurrent Cerebral Infarction Caused by Mobile Aortic Arch Thrombus Refractory to Warfarin Therapy

“…There have been a number of case presentations and studies on aortic thrombus. Song et al [ 8 ] reported aortic arch thrombus-induced cerebellar infarction in patients without risk factors of thrombus, while William et al [ 9 ] announced aortic thrombus-induced acute peripheral embolism cases in 20 patients with normal aorta. In the case of this report, aortic arch thrombi were complex thrombus plaques of 9.6 and 8 mm in size, which engendered embolic cerebral infarction in the territories of anterior and middle cerebral artery four times over a course of 18 months.…”

A case of massive aortic thrombosis with catastrophic cerebrovascular embolization and infarction

“…The major source of arterial systemic emboli is the heart, whereas systemic thrombi originating in the aorta are much less common. The occurrence of the thrombi without underlying predisposing conditions such as structural heart disease or atherosclerotic plaque would make the case even more unusual [6].…”