Advertisement
Heart, Lung and Circulation
Clinical Spotlight| Volume 23, ISSUE 3, e88-e91, March 2014

A Case of Mobile Aortic Arch Thrombus with Systemic Embolisation—A Management Dilemma

Published:November 14, 2013DOI:https://doi.org/10.1016/j.hlc.2013.09.009
      We report the case of splenic infarct secondary to embolisation from a polypoid 17 mm × 10 mm thoracic aorta thrombi in a 60 year-old female. The management and prognostic value of thoracic aorta thrombi are poorly defined in literature. This patient was successfully treated with oral anticoagulation as opposed to surgical intervention. Repeat transoesophageal echocardiography and computed tomography have demonstrated marked reduction in thrombi size with no further embolic event.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Heart, Lung and Circulation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Tunick P.A.
        • Nayar A.C.
        • Goodkin G.M.
        • Mirchandani S.
        • Francescone S.
        • Rosenzweig B.P.
        • et al.
        Effect of treatment on the incidence of stroke and other emboli in 519 patients with severe thoracic aortic plaque.
        Am J Cardiol. 2002; 90: 1320-1325
        • Tsilimparis N.
        • Hanack U.
        • Pisimisis G.
        • Yousefi S.
        • Wintzer C.
        • Ruckert R.I.
        Thrombus in the non-aneurysmal, non-atherosclerotic descending thoracic aorta – an unusual source of emboli.
        Eur J Vasc Endovasc Surg. 2011; 41: 450-457
        • Ferrari E.
        • Vidal R.
        • Chevallier T.
        • Baudouy M.
        Atherosclerosis of the thoracic aorta and aortic debris as a marker of poor prognosis: benefit of oral anticoagulants.
        J Am Coll Cardiol. 1999; 33: 1317-1322
        • Tunik P.A.
        • Kronzon I.
        Atheromas of the thoracic aorta: clinical and therapeutic update.
        J Am Coll Cardiol. 2000; 35: 545-554
        • Cohen A.
        • Amarenco P.
        Atherosclerosis of the thoracic aorta: from risk stratification to treatment.
        Am J Cardiol. 2002; 90: 1333-1335
        • Dressler F.A.
        • Craig W.R.
        • Castello R.
        • Labovitz A.J.
        Mobile aortic atheroma and systemic emboli: efficacy of anticoagulation and influence of plaque morphology on recurrent stroke.
        J Am Coll Cardiol. 1998; 31: 134-138
        • Choukroun E.M.
        • Labrousee L.M.
        • Madonna F.P.
        • Deville C.
        Mobile thrombus of the thoracic aorta: diagnosis and treatment in 9 cases.
        Ann Vasc Surg. 2002; 16: 714-722
        • Hassan I.
        • Zehr K.J.
        • Freeman W.K.
        A case of asymptomatic thoracic aorta mural thrombi.
        Ann Thorac Surg. 2001; 72: 1735-1737
        • Pagni S.
        • Trivedi J.
        • Ganzel B.L.
        • Williams M.
        • Kappor N.
        • Ross C.
        • et al.
        Thoracic aortic mobile thrombus: is there a role for early surgical intervention.
        Ann Thorac Surg. 2011; 91: 1875-1881
        • The Stroke Prevention in Atrial Fibrillation Investigators Committee on Echocardiography
        TEE correlates of thromboembolism in high-risk patients with nonvalvular atrial fibrillation.
        Ann Intern Med. 1998; 128: 639-647
        • The French study of aortic plaques in stroke group
        Atherosclerotic disease of the aortic arch as a risk factor for recurrent ischaemic stroke.
        N Engl J Med. 1996; 334: 1216-1221
        • Machleder H.I.
        • Takiff H.
        • Lois J.F.
        • Holburt E.
        Aortic mural thrombus: an occult source of arterial thromboembolism.
        J Vasc Surg. 1986; 4: 473
        • Karalis D.G.
        • Chandrasekaran K.
        • Victor M.F.
        • Ross Jr., J.J.
        • Mintz G.S.
        Recognition and embolic potential of intraaortic atherosclerosis debris.
        J Am Coll Cardiol. 1991; 17: 73-78
        • Amarenco P.
        • Duyckaerts C.
        • Tzourio C.
        • Henin D.
        • Bousser M.G.
        • Hauw J.J.
        The prevalence of ulcerated plagues in the aortic arch in patients with stroke.
        N Engl J Med. 1992; 326: 221-225
        • Kolvekar S.K.
        • Chaubey S.
        • Firmin R.
        Floating thrombus in the aorta.
        Ann Thorac Surg. 2001; 72: 925-927
        • Craig W.R.
        • Dressler F.A.
        • Vaughn L.M.
        • Castello R.
        • Dolan M.
        • Labovitz A.J.
        Mobile aortic debris in patients with cerebral ischemia: serial morphologic changes seen on repeat transesophageal echocardiography (abstr).
        J Am Soc Echocardiogr. 1996; 9: 364
        • Wells K.E.
        • Alexander J.
        • Piotrowski J.J.
        • Finkelhor R.S.
        Massive aortic thrombus detected by transesophageal echocardiography as a cause of peripheral emboli in young patients.
        Am Heart J. 1996; 132: 882-883
        • Hahn T.L.
        • Dalsing M.C.
        • Sawchuk A.P.
        • Cikrit D.F.
        • Lalka S.G.
        Primary aortic mural thrombus: presentation and treatment.
        Ann Vasc Surg. 1999; 13: 52-59
        • Stollberger C.
        • Kopsa W.
        • Finsterer J.
        Resolution of an aortic thrombus under anticoagulant therapy.
        Eur J Cardiothorac Surg. 2001; 20: 880-882