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

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.

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Peng Yang ◽  
Ya Li ◽  
Yao Huang ◽  
Chen Lu ◽  
Weitao Liang ◽  
...  

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.


2011 ◽  
Vol 46 (9) ◽  
pp. 586-593 ◽  
Author(s):  
Scott M. Thompson ◽  
Juan C. Ramirez-Giraldo ◽  
Bruce Knudsen ◽  
Joseph P. Grande ◽  
Jodie A. Christner ◽  
...  

Author(s):  
Frederik Pauwels ◽  
Angela Hartmann ◽  
John Al-Alawneh ◽  
Paul Wightman ◽  
Jimmy Saunders

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
P Poskaite ◽  
M Pamminger ◽  
C Kranewitter ◽  
C Kremser ◽  
M Reindl ◽  
...  

Abstract Funding Acknowledgements Type of funding sources: None. Background The natural history of thoracic aortic aneurysm (TAA) is one of progressive expansion. Asymptomatic patients who do not meet criteria for repair require conservative management including ongoing aneurysm surveillance, mostly carried out by contrast-enhanced computed tomography angiography (CTA). Purpose To prospectively compare image quality and reliability of a prototype non-contrast, self-navigated 3D whole-heart magnetic resonance angiography (MRA) with contrast-enhanced computed tomography angiography (CTA) for sizing of thoracic aortic aneurysm (TAA). Methods Self-navigated 3D whole-heart 1.5 T MRA was performed in 20 patients (aged 67 ± 8.6 years, 75% male) for sizing of TAA; a subgroup of 18 (90%) patients underwent additional contrast-enhanced CTA on the same day. Subjective image quality was scored according to a 4-point Likert scale and ratings between observers were compared by Cohen’s Kappa statistics. Continuous MRA and CTA measurements were analyzed with regression and Bland-Altman analysis. Results Overall subjective image quality as rated by two observers was 1 [interquartile range (IQR) 1-2] for self-navigated MRA and 1.5 [IQR 1-2] for CTA (p = 0.717). For MRA a perfect inter-observer agreement was found for presence of artefacts and subjective image sharpness (κ=1). Subjective signal inhomogeneity correlated highly with objectively quantified inhomogeneity of the blood pool signal (r = 0.78-0.824, all p <0.0001). Maximum diameters of TAA as measured by self-navigated MRA and CTA showed excellent correlation (r = 0.997, p < 0.0001) without significant inter-method bias (bias -0.0278, lower and upper limit of agreement -0.74 and 0.68, p = 0.749). Inter- and intraobserver correlation of aortic aneurysm as measured by MRA was excellent (r = 0.963 and 0.967, respectively) without significant bias (all p ≤ 0.05). Conclusion Self-navigated 3D whole-heart MRA enables reliable contrast- and radiation free aortic dilation surveillance without significant difference to standardized CTA while providing predictable acquisition time and by offering excellent image quality. Abstract Figure.


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