title: Ascending aorta thrombus adjacent to a cholesterol-rich plaque as the source of multiple emboli.
abstract: Ascending aortic thrombus causing thromboembolism in the absence of hyper-coagulable states is a rare occurrence. We present a case of a 40-year old healthy female smoker who presented with a 6-month history of three transient ischaemic attacks, hand pain and numbness despite being on dual anti-platelet therapy. Computed tomography revealed a mid-ascending aorta thrombus. She underwent ascending aorta replacement on cardiopulmonary bypass, but without the use of circulatory arrest. She recovered uneventfully. We identified a fresh thrombus adjacent to a soft, cholesterol-rich plaque as the culprit lesion. We advocate surgical excision of such lesions as the only way of removing the underlying cause of thromboembolism. In addition, rupture-prone aortic plaques may lead to a penetrating aortic ulcer or an intramural haematoma and ultimately aortic dissection.
authors.affiliation: Department of Cardiothoracic Surgery, St Thomas' Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK. mmsabetai@hotmail.com
authors.forename: Michael M
authors.initials: MM
authors.lastname: Sabetai
authors.forename: Allan M
authors.initials: AM
authors.lastname: Conway
authors.forename: George
authors.initials: G
authors.lastname: Hallward
authors.forename: Vinayak
authors.initials: V
authors.lastname: Bapat
mesh_terms: D000328:Adult; D001018:Aortic Diseases / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D001027:Aortography / Q000379:methods; D050197:Atherosclerosis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation; D002315:Cardiopulmonary Bypass; D002784:Cholesterol / Q000032:analysis*; D005260:Female; D006801:Humans; D006987:Hypesthesia / Q000209:etiology; D002546:Ischemic Attack, Transient / Q000209:etiology; D010146:Pain / Q000209:etiology; D058226:Plaque, Atherosclerotic; D013923:Thromboembolism / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D013927:Thrombosis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D002784:Cholesterol