Aortic arch thrombosis complicated by an embolic stroke in a patient with COVID-19: A case report

Abstract

Introduction Aortic thrombosis is an uncommon condition with serious embolic complications. COVID-19 is currently recognized to be associated with both venous and arterial thrombosis. However, only a limited number of COVID-19 cases associated with aortic thrombosis have been reported in the literature since the beginning of the pandemic. Case presentation A 66-year-old lady was admitted to our hospital with acute ischemic stroke. Floating aortic arch thrombus was detected incidentally on CT imaging. Interestingly, the patient reported a history of fever and cough and was found to have COVID-19 pneumonia based on nasopharyngeal polymerase chain reaction (PCR) and imaging. The patient received three months of anticoagulant therapy, and repeated imaging study did not reveal any aortic thrombus. Clinical discussion COVID-19 related aortic thrombosis has been reported chiefly in severe cases. The SARS-CoV-2 can directly infect the endothelium of the vessels, which might explain the occurrence of arterial thrombosis in milder COVID-19 cases with the absence of the hyperinflammatory state. The management guideline for aortic thrombosis is scarce and based only on case reports and series. Conclusion Aortic thrombosis is a devastating condition that can be easily missed without clinical suspicion. Our patient developed acute ischemic stroke, most likely embolic originating from the aortic thrombus. The clinician should consider this condition in any COVID-19 patient presenting with thromboembolic events, such as stroke or acute limb ischemia. Further study is required to explain the pathophysiology of arterial/venous thrombosis in mild-moderate COVID-19 cases.

Acute Aortic Syndrome in a patient with COVID-19

“…Kashi et al [ 9 ] reported 2 cases of asymptomatic aortic thrombus, both incidental diagnoses detected on a pulmonary angiography. Al-Mashdali et al [ 10 ] reported the case of a patient, infected with the SARS-CoV-2 virus, with an embolic stroke originating from an aortic arch thrombus. Similar to our patient, these subjects had a history of cardiovascular disease and a medical approach was decided in all of them.…”