title: Giant thrombus in the ascending aorta that caused systemic embolism.
abstract: Although an ascending aortic thrombus is a rare finding, it may cause major embolic complications. We report a case of a 58-year-old male who suffered from cerebral and left renal infarctions due to emboli from a giant thrombus in the ascending aorta. The thrombus was demonstrated by computed tomography and transesophageal echocardiography. Ten days after the initiation of anticoagulation therapy, surgery was performed. After a median sternotomy was performed and cardiopulmonary bypass was initiated, the ascending aorta was replaced with a synthetic graft under hypothermic circulatory arrest and retrograde cerebral perfusion. The excised specimen revealed a 3.5×3.0×3.0-cm pedunculated thrombus. The patient's postoperative recovery was uneventful, and there was no recurrence of aortic thrombosis during one year of postoperative follow-up. The patient had no coagulation disorders, and the etiology of this giant thrombus remains unclear. We believe that initial treatment for an ascending aortic thrombus should be emergency surgery before it leads to major embolic events. However, the treatment strategy for a thrombus causing cerebral infarction is sometimes difficult to develop.
authors.affiliation: Department of Cardiovascular Surgery, Teikyo University Hospital, Itabashi-Ku, Tokyo 173-8605, Japan. qrsaro-ck@yahoo.co.jp
authors.forename: Takahiro
authors.initials: T
authors.lastname: Sawada
authors.forename: Tomoki
authors.initials: T
authors.lastname: Shimokawa
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D001018:Aortic Diseases / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D001706:Biopsy; D019917:Blood Vessel Prosthesis Implantation; D002544:Cerebral Infarction / Q000209:etiology; D017548:Echocardiography, Transesophageal; D004617:Embolism / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012078:Renal Artery Obstruction / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D017131:Thrombectomy; D013927:Thrombosis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants