Floating thrombus in the aorta

A review of the literature shows that there are few reported cases of embolism or thrombus in a nonaneurysmal, effectively normal aorta with no other underlying reason for thrombus formation in the aorta. We report a case of a large, floating thrombus in the descending aorta lumen and discuss surgical and management options.     

Floating thrombus in the ascending aorta

Floating thrombus in the ascending aorta is an uncommon source of embolism. We report a case of a 61-year-old man who was admitted to our hospital for transient brain ischemic attack. Transesophageal echocardiography showed a floating mass on the sinotubular junction. We started anticoagulation therapy immediately and performed surgical removal of the mass 5 days after the admission. Postoperative course was uneventful. He is now in good health and has no sign of recurrence. The etiology of this case is unclear, and the strategy is difficult to determine in terms of cerebral complications.     

Floating nonocclusive thrombus in the ascending aorta

We report the case of a 55-year-old woman seen with signs of angina pectoris and dyspnea. Transesophageal echocardiography showed a floating thrombus distal to the right coronary ostium. At operation, we found a highly mobile thrombus attached to an atherosclerotic plaque distal to the right coronary ostium. The atherosclerotic lesion and the pedunculated thrombotic mass were removed without resection of the adjacent aortic wall. In our judgment, a floating mass in the ascending aorta represents an emergency and should be removed before major thromboembolic complications occur.     

Organized thrombus in the ascending aorta originating from the ostium of the right coronary artery.

This case report describes the rare finding of a pedunculate thrombus in the ascending aorta originating from the ostium of the right coronary artery (RCA) detected after an inferior wall myocardial infarction in a young female. The thrombus was removed surgically during an emergency cardiopulmonary bypass procedure     

Endovascular treatment for mobile thrombus of the thoracic aorta.

Detection levels of mobile thrombus of the thoracic aorta have greatly increased after any embolic event. Although the indication for treatment remains controversial, there is a growing interest about the etiopathogenesis of this rare entity and to define proper diagnostic and therapeutic approaches. We present a case of mobile thrombus of the thoracic aorta causing recurrent peripheral emboli managed with endovascular stent graft.     

Endovascular stent graft for symptomatic mobile thrombus of the thoracic aorta

Mobile thoracic aortic thrombus is a potential source of arterial embolism. Therapeutic management remains controversial. Systemic anticoagulation and various open surgical procedures are the commonly used therapeutic modalities. We report the successful primary treatment by endovascular stent graft of a mobile thoracic aortic thrombus that had caused visceral and peripheral embolism. Our case shows that endovascular stent-graft treatment is an effective, minimally invasive treatment of symptomatic mobile thoracic aortic thrombus.     

Mobile thrombus of the thoracic aorta: diagnosis and treatment in 9 cases

Detection of mobile thrombus of the thoracic aorta has become increasingly common thanks to routine exploration using transesophageal echography (TEE) after any embolic event. Although the indication for treatment remains controversial, there is a growing interest in understanding this potential source of arterial emboli and in defining proper diagnostic and therapeutic approaches. The purpose of this study was to evaluate the utility of different diagnostic and therapeutic modalities used in our department over the last 6 years. Between 1995 and 2000, mobile thrombus of the thoracic aorta was diagnosed in 9 patients (5 men, 4 women) with a mean age of 49.2 years (range, 28 to 68 years). In all patients, aortic thrombus was suspected after a peripheral (n = 4) or cerebral (n = 5) vascular event. Treatment using intravenous heparin was attempted in all patients and allowed complete dissolution of thrombus in four. In the remaining five patients, repeat TEE demonstrated persistent thrombus and operative treatment was undertaken. In three patients with thrombosis in the aortic arch, thrombectomy was performed with cardiopulmonary bypass, and deep hypothermic circulatory arrest. In two patients presenting thrombosis in the descending thoracic aorta, thrombectomy was performed with an atriofemoral shunt. Thrombectomy was associated with repair of a wall defect in two patients and resection of atheromatous plaque in one patient. Postoperative recovery was uneventful but recurrence was noted in one patient because anticoagulation therapy was stopped too soon. On the basis of our experience and previous reports, we have defined the following therapeutic strategy. All patients are first treated with heparin. In case of failure, thrombectomy may be undertaken in young patients. Because of the highly invasive nature of the procedure, careful work-up including TEE should be performed to rule out any other cause of embolism and to determine that the lesion presents a high potential for embolism. Follow-up must include long-term coumadin therapy and routine surveillance using TEE or magnetic resonance imaging, since long-term outcome is unclear.     

Recurrent systemic embolism: look for a thrombus in... the thoracic aorta

Thoracic aortic mural thrombus is a rare entity and potential source of serious systemic emboli. The progress of computed tomography (CT) angiography and the current use of transesophageal echocardiography (TEE) after any embolic event have considerably increased the frequency of diagnostic and there is a growing interest about the etiopathogenesis, which is still widely misunderstood. Therapeutic management remains controversial. We present a case of floating thrombus in the thoracic aorta detected by contrast-enhanced CT scan. This thrombus was responsible for two close major embolic events and was therefore managed surgically. Finally, outcome was favorable.     

Aortobronchial fistula developing from an infectious aneurysm of the thoracic aorta

Aortobronchial fistula presenting as massive haemoptysis is a rapidly fatal process if not promptly diagnosed and repaired. It's an unusual complication of thoracic aneurysm. We report the case of a 61-year-old woman with rupture of a thoracic aortic infectious aneurysm secondary to an Escherichia coli infection. Aortobronchial fistula diagnosis should be considered in patients who have minor or major haemoptysis and correct diagnostic procedures should be performed early. An aggressive surgical approach is often necessary.     

Abnormal systemic artery originating from descending aorta to normal basal segments of left lung. Report 2 cases

Two patients with a large abnormal systemic artery originating from the descending aorta several centimeters above the diaphragm to the four basal segments of normal left lower lobe (without cystic change like that found in the bronchopulmonary sequestration) were treated. No pulmonary artery was found to supply the basal segments. The patients suffered from repeated hemoptysis. In one patient the abnormal artery was incidentally found during bronchial arteriography. Lower lobectomy was performed in the two patients. Microscopic examination of specimens revealed some dilated small blood vessels with extremely thin walls and their rupture may be the cause of hemoptysis. Abnormal systemic artery must be suspected if hemoptysis or local murmur during chest examination cannot be explained by other conditions, and care must be taken not to injure the artery in isolating pleural adhesion and pulmonary ligament.     

Mural thrombus of the aorta

Twenty-six peripheral arterial emboli complicating 14 cases of mural thrombi of the aorta were diagnosed between January 1978 and December 1986. None of these patients had any cardiovascular history; their mean age was 49 years. Presenting signs were acute ischemia of the lower limbs in 12 cases and chronic ischemia in two. Arteriograms and CT scan were diagnostic. The mural thrombi were infrarenal in 13 cases and suprarenal in one. Treatment of the thrombus was surgical in all but one patient. In four cases, treatment of the underlying cause was simultaneous with embolectomy; in nine patients, treatment was secondary because further workup was needed. In one case, the patient died following embolectomy before definitive treatment could be undertaken. Results were considered good in 11 cases (unlimited walking distance, no recurrent emboli), and poor in three cases (two major amputations and one death). The incidence of mural thrombi is not known. In our experience, they accounted for 3.8% of nonaneurysmal aortoiliac lesions operated upon during a nine-year period and were responsible for 5% of peripheral arterial emboli. Mural thrombosis of the aorta constitutes a dangerous condition with a potentially lethal final outcome. Recurrent emboli are inevitable without surgical treatment of the source.     

Recurrent embolism caused by floating thrombus originating from the ligamentum arteriosum.

Few patients with an embolism derived from apparently normal thoracic aorta with no other disease have been reported. We were presented with a case of a floating thrombus originating from the ligamentum arteriosum that caused multiple embolic episodes in the bilateral common iliac and superior mesenteric arteries. From our findings, we recommend a surgical approach for a floating thrombus in the aorta to prevent further embolism.