scholarly journals Hyperacute simultaneous cardiocerebral infarction related to floating thrombus in the ascending aorta: a case report

2021 ◽  
Author(s):  
Ranny Issa ◽  
Felix Gallissot ◽  
Alexandre Cochet ◽  
Yves Cottin
Keyword(s):  
Anticoagulant Therapy ◽  
Thrombus Formation ◽  
Case Reports ◽  
Arterial Embolization ◽  
Ascending Aorta ◽  
Surgical Risk ◽  
Floating Thrombus ◽  
Endovascular Interventions ◽  
Peripheral Embolization ◽  
Aortic Thrombus

Abstract Background Ascending aortic thrombus has been reported in several case reports, often revealed by peripheral embolization, but very few revealed by cardiocerebral infarction. Moreover, there is no defined treatment strategy. Case Summary An 83-year-old woman was admitted to our intensive care unit for concurrent acute myocardial infarction (AMI) and acute stroke, both with the presence of an embolism. Imaging revealed a floating thrombus in the ascending aorta. The thrombus resolved after anticoagulant therapy was administered, and there was no subsequent embolism recurrence. Discussion Floating thrombus in the ascending aorta is an unusual cause of AMI. The main mechanisms of thrombus formation include erosion of an atherosclerotic plaque, but it can also form without tissue abnormality with the probable implication of Virchow’s triad. However, the precise mechanism for thrombogenesis remains unknown. In patients with a low surgical risk, we should consider surgical treatment, especially as anticoagulant therapy does not appear to reduce the risk of arterial embolization. Thrombolysis and endovascular interventions have also proven effective in certain cases. Overall, in patients with high surgical risk, decision will have to be made on a case-by-case basis. Learning point Ascending aortic thrombus should be suspected in cases of multiple systemic embolisms. Simultaneous AMI and ischemic stroke should lead to a search for arterial embolization, and it could be useful to perform a head and chest CT scan prior to cardiac catheterization in case of neurologic symptoms in the context of AMI.

scholarly journals Floating thrombus in the ascending aorta revealed by peripheral arterial embolism

2020 ◽  
Vol 30 (5) ◽  
pp. 762-764
Author(s):  
Majdi Gueldich ◽  
Mariantonietta Piscitelli ◽  
Haytham Derbel ◽  
Khaoula Boughanmi ◽  
Eric Bergoend ◽  
...  
Keyword(s):  
Aortic Wall ◽  
Arterial Embolization ◽  
Ascending Aorta ◽  
Surgical Removal ◽  
Systemic Embolism ◽  
Arterial Embolism ◽  
Floating Thrombus ◽  
Aortic Thrombus ◽  
Surgical Thrombectomy ◽  
Peripheral Arterial

Abstract A floating thrombus in the ascending aorta is rarely found in clinical practice and is an uncommon cause of peripheral arterial embolization. When there is minimal atherosclerosis or a normal aorta, the management of such a lesion is poorly defined. Currently, there is no clear consensus concerning optimal treatment. Herein, we report 2 cases of ascending aortic thrombus that are complicated by a peripheral embolic event. Due to the risk of recurrent systemic embolism, particularly with strokes, surgical thrombectomy with ascending aortic wall replacements was performed. We believe that floating ascending aorta thrombus represents a serious source of systemic embolism and stroke. Surgical removal is easy to perform with good clinical outcomes. Conservative treatments such as anticoagulation or thromboaspiration may be considered in high-risk or inoperable patients.

scholarly journals A giant floating thrombus in the ascending aorta: a case report

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Peng Yang ◽  
Ya Li ◽  
Yao Huang ◽  
Chen Lu ◽  
Weitao Liang ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Thrombus Formation ◽  
Attachment Site ◽  
Filling Defect ◽  
Ascending Aorta ◽  
Floating Thrombus ◽  
Contrast Enhanced ◽  
Aortic Thrombus ◽  
Therapeutic Recommendations ◽  
Enhanced Computed Tomography

Abstract Background A floating thrombus in an ascending aorta with normal morphology is very rare, but when it does occur, it may induce a systemic embolism or fatal stroke. The pathophysiological mechanisms of aortic mural thrombi remain unclear, and there is no consensus regarding therapeutic recommendations. Case presentation We report a 49-year-old male who presented with chest discomfort for 5 days and was admitted to our emergency unit. A contrast-enhanced computed tomography angiography (CTA) surprisingly demonstrated a large filling defect suggestive of a thrombus in his otherwise healthy distal ascending aorta. Surgical resection of the mass and attachment site was performed. Histological examination confirmed that the mass was a thrombus, but the cause of the thrombus formation was unknown. Conclusions floating aortic thrombi are rare, and they are prone to break off, thus carrying a potential risk for embolic events with catastrophic consequences. Surgical resection, both of the aortic thrombus and attachment site, as well as postoperative anticoagulant administration, are standard treatments.

scholarly journals Asymptomatic floating thrombus in the ascending aorta depicted on four-dimensional computed tomography

2020 ◽  
Vol 8 ◽  
pp. 2050313X2097189
Author(s):  
Takamasa Nishimura ◽  
Eijun Sueyoshi ◽  
Yuichi Tasaki ◽  
Masataka Uetani
Keyword(s):  
Computed Tomography ◽  
Unusual Case ◽  
Ascending Aorta ◽  
Mural Thrombus ◽  
4D Ct ◽  
Floating Thrombus ◽  
Contrast Enhanced ◽  
Aortic Thrombus ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography

Aortic mural thrombi of the ascending aorta are rare. If an aortic mural thrombus is dislodged, it can cause various embolic complications, which can sometimes be fatal. Although contrast-enhanced computed tomography (CT) and transesophageal echography are useful for diagnosing aortic mural thrombi, four-dimensional CT (4D-CT) is one of the most useful modalities for both diagnosis and treatment selection in such cases. 4D-CT can be used to evaluate the morphology and mobility of thrombi. Furthermore, it is minimally invasive. To the best of our knowledge, there have not been any reports about 4D-CT being used to depict an asymptomatic ascending aortic thrombus. We report a very unusual case, involving an aortic mural thrombus of the ascending aorta.

480 Successful anticoagulation treatment of an ascending aortic thrombus associated with myocardial infarction and systemic embolism

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
P Ng ◽  
A Rajwani ◽  
C Schultz
Keyword(s):  
Myocardial Infarction ◽  
Hypertrophic Cardiomyopathy ◽  
Complete Resolution ◽  
Thrombus Formation ◽  
Ascending Aorta ◽  
Heart Team ◽  
Systemic Embolism ◽  
Arm Pain ◽  
Aortic Thrombus ◽  
The Right

Abstract Background The ascending aorta is an uncommon site for non-infective mural thrombus. The detection of such a thrombus is of particular importance, given the risk of systemic and coronary embolisation. We present a case of a 60-year-old female with an ascending aortic thrombus complicated by non-ST-elevation myocardial infarction (NSTEMI), and associated systemic embolism in the form of renal and splenic infarcts. Case Report A 60-year-old female was admitted to a local secondary hospital with a 4-day history of crampy abdominal pain and intermittent bilateral arm pain associated with nausea and vomiting. Past medical history included known hypertrophic cardiomyopathy, gastroesophageal reflux disease, carpal tunnel syndrome, hepatic steatosis, but no known thrombophilia or coronary artery disease. Computer tomography (CT) scan of the abdomen revealed subacute infarction of the right kidney and spleen in keeping with a thrombo-embolic event. A CT pulmonary angiogram revealed a small pulmonary embolus in the right lower lobe. Troponin I level was elevated at 11 mg/L (normal <0.04 mg/L). She was treated with aspirin, clopidogrel and therapeutic enoxaparin for a NSTEMI, and transferred to a metropolitan tertiary centre for ongoing investigation. A transthoracic echocardiogram performed showed known hypertrophic cardiomyopathy, but negative for intracardiac shunting via bubble study. Coronary angiography revealed an acutely occluded distal left anterior descending (LAD) artery with no collaterals, and mild irregularities in all other coronary arteries. A transoesophageal echocardiogram performed to exclude any intracardiac sources of emboli showed a pedunculated and mobile non-calcific mass measuring 1.0cm X 0.5cm in the posterior aspect of the ascending aorta, associated with atheroma in the aortic arch. A laboratory workup for antiphospholipid syndrome, antithrombin III, protein S and protein C deficiency were negative. After discussion with the multidisciplinary Heart team, the consensus was that the aortic mass was likely thrombus formation relating to erosion of aortic atheroma. It was hypothesised that this may have resulted in distal embolisation to the left kidney and spleen, and possibly also caused embolisation to the LAD artery, although the cause of the pulmonary embolism was still unknown. The patient was then discharged on rivaroxaban and aspirin. A repeat transoesophageal echocardiogram was performed 4 months after discharge to assess the ascending aortic mass. It showed complete resolution of the mass in the ascending aorta, with no change in any other cardiac structures. Discussion Although thrombus formation is uncommon in the ascending aorta, certain conditions, such as pregnancy and thrombophilia increase its risk. Several case reports of ascending aortic thrombus were found in the literature, but this will be the first to report complete resolution with treatment using a direct oral anticoagulant. Abstract 480 Figure. Ascending Aortic Thrombus + Resolution

scholarly journals Large extracellular vesicles in the left atrial appendage in patients with atrial fibrillation—the missing link?

2021 ◽  
Author(s):  
Andreas Zietzer ◽  
Baravan Al-Kassou ◽  
Paul Jamme ◽  
Verena Rolfes ◽  
Eva Steffen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Extracellular Vesicles ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Thrombus Formation ◽  
Flow Cytometric Analysis ◽  
Heart Rhythm ◽  
Atrial Appendage ◽  
Peripheral Embolization

AbstractAtrial fibrillation (AF) is the most frequent arrhythmic disease in humans, which leads to thrombus formation in the left atrial appendage and stroke through peripheral embolization. Depending on their origin, large extracellular vesicles (lEVs) can exert pro-coagulant functions. In the present study, we investigated how different types of AF influence the levels of large EV subtypes in three distinct atrial localizations. Blood samples were collected from the right and left atrium and the left atrial appendage of 58 patients. 49% of the patients had permanent AF, 34% had non-permanent AF, and 17% had no history of AF. Flow cytometric analysis of the origin of the lEVs showed that the proportion of platelet-derived lEVs in the left atrial appendage was significantly higher in permanent AF patients compared to non-permanent AF. When we grouped patients according to their current heart rhythm, we also detected significantly higher levels of platelet-derived lEVs in the left atrial appendage (LAA) in patients with atrial fibrillation. In vitro studies revealed, that platelet activation with lipopolysaccharide (LPS) leads to higher levels of miR-222-3p and miR-223-3p in platelet-derived lEVs. Treatment with lEVs from LPS- or thrombin-activated platelets reduces the migration of endothelial cells in vitro. These results suggest that permanent atrial fibrillation is associated with increased levels of platelet-derived lEVs in the LAA, which are potentially involved in LAA thrombus formation.

Fatal Giant Aortic Thrombus Presenting With Pulmonary Edema in a Patient With Chronic Obstructive Pulmonary Disease

2007 ◽  
Vol 14 (4) ◽  
pp. 486-488 ◽  
Author(s):  
Ibrahim Sari ◽  
Vedat Davutoglu ◽  
Nazan Bayram ◽  
Serdar Soydinc
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Thrombus Formation ◽  
Cardiopulmonary Arrest ◽  
Rare Event ◽  
Diagnostic Methods ◽  
Chronic Obstructive ◽  
Low Back ◽  
Obstructive Pulmonary Disease ◽  
Aortic Thrombus

Thrombus formation in a morphologically normal a aorta is a very rare event. A 50-year-old man with a his- s tory of chronic obstructive pulmonary disease, pre- e sented to the emergency department with pulmonary C edema. Transthoracic and transesophageal echocardio- t graphy revealed a highly mobile, pedunculated floating c thrombus in the descending thoracic aorta 3-4 cm dis- t tal to the origin of the left subclavian artery. The orig- t inal lumen of the aorta was almost obliterated by the thrombus. The aortic wall was free of any atheroma. Thrombolytic treatment was administered, but 3 hours d after starting streptokinase, he developed sudden and severe low-back pain accompanied by loss of lower-extremity pulses which were patent on admission. Cardiopulmonary arrest developed within an hour and the patient died despite resuscitation. The potential causes of aortic thrombus, the clinical spectrum that the patients may present, diagnostic methods, and therapeutic options are discussed.

scholarly journals Catching a floating thrombus; a case report on the treatment of a large thrombus in the ascending aorta

2017 ◽  
Vol 12 (1) ◽  
Author(s):  
Gijs Eduard de Maat ◽  
Giorgio Vigano ◽  
Massimo Alessandro Mariani ◽  
Ehsan Natour
Keyword(s):  
Case Report ◽  
Ascending Aorta ◽  
Floating Thrombus

Large mural thrombus in the distal arch of the aorta without atherosclerotic disease

2021 ◽  
Vol 14 (8) ◽  
pp. e243493
Author(s):  
Mohammed M Uddin ◽  
Mohamad Amer Soudan ◽  
Joseph Sebastian ◽  
Tanveer Mir ◽  
Said Ashraf ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Complete Resolution ◽  
Imaging Study ◽  
Mural Thrombus ◽  
Endovascular Interventions ◽  
Surveillance Imaging ◽  
Aortic Thrombus ◽  
Systemic Anticoagulation ◽  
Arch Of The Aorta

Aortic mural thrombus (AMT) is an uncommon cause of arterial thromboembolism. It is very rare in patients without significant cardiovascular risk factors. Many aetiologies can cause AMT, but there are no clear guidelines for the evaluation and treatment. We present the case of a 43-year-old woman without arteriosclerotic disease who was admitted to the hospital with peripheral embolisation from the mural thrombus in the distal arch of the aorta. Therapy with systemic anticoagulation resulted in complete resolution without necessitating any surgical or endovascular interventions. There were no reported recurrence or complications of the intra-aortic thrombus within 1-year surveillance imaging study.

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