Floating intra-aortic thrombus presenting as distal arterial embolism.
Floating thrombi in the aorta are a rare finding in the absence of any coagulation abnormality. They often represent a surgical emergency. Our case refers to a 45-year-old woman who presented with acute ischemia of the upper extremity. This was a result of peripheral embolism originating in a floating thrombus in the ascending aorta. A free-floating lesion held by a pedicle from the lateral ascending aortic wall was demonstrated using computed tomography and magnetic resonance scans. There was no pre-existing clotting abnormality. Conservative treatment with oral anticoagulation was not successful in removing the lesion. Therefore, a surgical approach was selected through a median sternotomy and cardiopulmonary bypass. Under temporary hypothermic circulatory arrest, the ascending aorta was opened. The lesion was removed along with a rim of aortic wall, circulation was re-established and the aorta was reconnected with use of a synthetic interposition graft. Postoperative course was uneventful. The patient was discharged on oral anticoagulation. Histopathology confirmed the lesion as thrombus. Only a few cases of intra-aortic thrombus without any coagulation abnormality basis are described in literature. Occasionally, they present as distal embolism. Treatment should be surgical excision on cardiopulmonary bypass, a procedure performed safely with excellent outcome.
Pousios
Dimitrios
D
Department of Cardiothoracic Surgery, Wessex Cardiac Unit, Southampton General Hospital, Southampton, UK. dpousios@yahoo.com
Velissaris
Theodoros
T
Duggan
Simon
S
Tsang
Geoff
G
D000208:Acute Disease; D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage; D001018:Aortic Diseases / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation; D002315:Cardiopulmonary Bypass; D050792:Circulatory Arrest, Deep Hypothermia Induced; D004617:Embolism / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D005260:Female; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D002546:Ischemic Attack, Transient / Q000209:etiology; D018810:Magnetic Resonance Angiography; D008875:Middle Aged; D013249:Sternum / Q000601:surgery; D013927:Thrombosis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D034941:Upper Extremity / Q000098:blood supply*
D000925:Anticoagulants