Non-atherosclerotic aortic mural thrombus: a rare source of embolism

Abstract

A 54-year-old man presented to the emergency department with acute left-sided chest pain and left upper quadrant abdominal pain. He had a significant history of squamous cell carcinoma of the lung previously treated with right pneumonectomy who ; is currently receiving adjuvant chemotherapy with cisplatin. Physical examination was remarkable for tachycardia, hypertension and mild abdominal tenderness. CT angiography revealed an aortic mural thrombus in the ascending aorta and aortic arch without dissection, aneurysm or tortuosity of the aorta. In addition, an infarction of the inferior spleen was reported. Given the high risk of surgery for this patient, he was treated conservatively with esmolol and heparin infusion. His subsequent hospital course was uneventful, and he was successfully discharged on enoxaparin therapy that was successively bridged to rivaroxaban treatment. Follow-up transesophageal echocardiography and CT angiography at one month showed no thrombus in the aorta.

Direct oral anticoagulant therapy as an alternative to surgery for the treatment of a patient with a floating thrombus in the ascending aorta and pulmonary embolism

“…Hypercoagulability caused by blood disorders, malignant neoplasms, anticancer therapy, hormonal therapy, collagen diseases, and pregnancy is associated with the development of thrombi. 1 , 2 In this patient, the level of homocysteine, which has atherogenic and prothrombotic properties, was high. Furthermore, because nutritional deficiencies including vitamin B deficiency are highly prevalent in patients with sustained heavy alcohol consumption, 7 an elevated blood homocysteine level can reflect a deficiency in folate, vitamin B 6 , or vitamin B 12 .…”

“…Several authors have reported successful results using anticoagulants, such as warfarin, for the treatment of aortic thrombi. 1 , 5 , 16 Marin-Acevedo et al 2 reported complete resolution of an ascending aortic thrombus using rivaroxaban. Although the optimal drug, dose, and duration of anticoagulation therapy are crucial, they are not established.…”

“… 1 Aortic thrombosis is reportedly caused by atherosclerosis and hypercoagulability. 2 However, in some cases, the cause can be difficult to determine. 3 We describe the case of a patient with a floating thrombus in the ascending aorta, pulmonary embolism, and slightly elevated homocysteine level.…”

Large de novo ascending aortic thrombus successfully treated with anticoagulation

“…An ascending aortic thrombus is a very rare source of embolic TIA or stroke without an associated aortic pathology, such as aortic dissection, atherosclerosis, or aortic aneurysm. There have only been prior case reports in the ascending aorta 1 , 2 and descending aorta. 3 The exact mechanism of thrombus formation in these patients is not well understood.…”

Computed Tomography Angiography (CTA) Features of Aortic Floating Thrombus: Five Case Reports and Literature Review

“…A hypercoagulable state and aortic disease are the main etiologies of AFT (1,2). In computed tomography angiography (CTA) of the aorta, AFT has been mostly found in the thoracic and abdominal aortas, while it is rarely found in the ascending aorta.…”