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.

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 Inferior Vena Cava Thrombus due to Left Inferior Vena Cava and Ulcerative Colitis

TH Open ◽  
2018 ◽  
Vol 02 (04) ◽  
pp. e369-e370
Author(s):  
Hirofumi Arai ◽  
Akira Mizukami ◽  
Kenji Yoshioka ◽  
Shunsuke Kuroda ◽  
Ryota Iwatsuka ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Abdominal Pain ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Thrombus Formation ◽  
Left Renal Vein ◽  
Vena Cava ◽  
Crossing Over ◽  
Contrast Enhanced ◽  
Enhanced Computed Tomography

AbstractA 29-year-old man with diarrhea and abdominal pain for 2 weeks presented with new-onset left back pain. Contrast-enhanced computed tomography (CT) showed a left inferior vena cava (IVC) crossing over the aorta, and thrombus in the IVC and left renal vein. Colonoscopy and biopsy for assessment of diarrhea and abdominal pain provided a diagnosis of ulcerative colitis. Stasis of blood flow due to left IVC crossing over the aorta, and hypercoagulability due to ulcerative colitis influenced thrombus formation.

scholarly journals MASSIVE MURAL AORTIC ARCH THROMBUS.

2021 ◽  
Author(s):  
Ali Ayaon Albarrán ◽  
Jose Ignacio Juarez Del Rio ◽  
María Mercedes Campos Sanz ◽  
Cristina Rodríguez Alcalá
Keyword(s):  
Ct Angiography ◽  
Axillary Artery ◽  
Filling Defect ◽  
Aortic Disease ◽  
Ascending Aorta ◽  
Left Middle Cerebral Artery ◽  
Aortic Thrombus ◽  
Left Middle ◽  
Hypothermic Arrest ◽  
Treatment Surgery

Mural aortic thrombus is a rare pathology that is more frequently seen in severe atherosclerotic aortic walls, in aneurysms and acute aortic syndrome(1). However this can be found in patients without aortic disease, and be responsible for systemic or cerebral emboli. A 54-year-old male was admitted to our institution for syncope and aphasia, he was found in the street with ethylic intoxication. After neurological examination mixed type aphasia was observed, cerebral and supra aortic arteries CT angiography were performed. Cerebral CT showed focal filling defect of left middle cerebral artery. Supra aortic arteries CT angiography was completed with toracoabdominal CT because massive ascending and arch thrombus was found. The thrombus measured 130 x 33 x 15 mm (Figures 1A and 1B and 1C), and covered from mid ascending aorta to 40 mm distal to the ostium of left subclavian artery. The patient was referred to our unit for urgent surgical treatment. Surgery was performed throw median sterntomy, cardiopulmonary bypass with moderate hypothermic arrest and anterograde cerebral perfusion via right axillary artery. Longitudinal aortotomy was made and 140 x 30 x 15 mm thrombus (Figure 2), attached to posterior mid ascending aorta, was found and resected, the aortic wall did not show any abnormality. The patient had an eventful recovery and was discharged 9 days later with oral anticoagulation and aspirin.

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.

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

Cystic adventitial disease of the common femoral vein: A case report

Vascular ◽  
2020 ◽  
Vol 28 (4) ◽  
pp. 489-493
Author(s):  
Facai Guo ◽  
Yi Guo
Keyword(s):  
Surgical Resection ◽  
Femoral Vein ◽  
Vascular Disorder ◽  
Common Femoral Vein ◽  
Contrast Enhanced ◽  
The Common ◽  
One Year ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography

Objectives Cystic adventitial disease is an extremely rare vascular disorder and is often misdiagnosed. In order to improve the knowledge and treatment of this disease, a case of venous cystic adventitial disease was reported. Methods The whole processes about the diagnosis and treatment of one patient with venous cystic adventitial disease was retrospectively studied. Results This case of venous cystic adventitial disease was diagnosed accurately by contrast-enhanced computed tomography and treated successfully by surgical resection. No complications were detected after one-year post-operative follow-up. Conclusions Surgical resection is a safe and effective method for the treatment of venous CAD.

scholarly journals Fluttering cord-like thrombus in the aortic arch: a case report

2021 ◽  
Author(s):  
Yuki Kuroda ◽  
Akira Marui ◽  
Yoshio Arai ◽  
Atsushi Nagasawa ◽  
Shinichi Tsumaru ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Aortic Arch ◽  
Histopathological Examination ◽  
Circulatory Arrest ◽  
Selective Cerebral Perfusion ◽  
Cervical Incision ◽  
Contrast Enhanced ◽  
Aortic Thrombus ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography

Abstract BackgroundOptimal treatment for aortic thrombus remains to be determined, but surgical treatment is indicated when there is a risk for thromboembolism. Case PresentationA 47-year-old male presented with weakness in his left arm upon awakening. Contrast-enhanced computed tomography and transesophageal echocardiography revealed a mobile pedunculated object suggestive of a thrombus arising from the ascending aorta and extending to the left common carotid artery. It was removed under hypothermic circulatory arrest and direct cannulation of the left carotid artery to avoid carotid thromboembolism. Histopathological examination revealed that the object was a thrombus. The patient had an uneventful postoperative course and was discharged 9 days after surgery. ConclusionWhen a thrombus in the aortic arch extends to the neck arteries, direct cannulation of the neck arteries with selective cerebral perfusion via cervical incision is a useful technique.

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