Thoracic aortic mural thrombi are rare in clinical practice, especially in non-aneurysmatic or nonatherosclerotic vessels. They are typically located in the descending aorta, and less frequently in the aortic arch, abdominal aorta, and ascending aorta. Although they are a rare cause of arterial embolization, this is their main manifestation. We present the case of a 48-year-old man, with no cardiovascular risk factors or history of trauma, who presented with acute arterial ischemia of the right upper limb. From the initial investigation, we highlight the presence of a pedunculated mass in the distal portion of the ascending aorta with signs of instability. Due to the risk of additional embolization, the patient was submitted to urgent surgery, with excision of the aortic defect, implantation of a tubular prosthesis as well as thromboembolectomy of the right brachial artery. The etiological evaluation of mural aortic thrombi is challenging and implies the exclusion of some prothrombotic conditions known to predispose to arterial thrombosis. This is a rare case that emphasizes the importance of considering the aorta as a possible source of peripheral embolization, even when there is no significant atherosclerotic or aneurysmatic disease.

Primary splenic lymphoma (PSL) is a rare disease and an improbable cause of splenomegaly or splenic nodules. On the contrary, splenic secondary involvement as part of an advanced lymphoproliferative disorder is more common. The authors present the case of a 49-year-old woman with a primary splenic diffuse large B-cell lymphoma (PS-DLBCL), in which the absence of other organs’ involvement determined an ultrasound-guided biopsy of the spleen to achieve a definitive diagnosis. With this case the authors intend to emphasise the extensive differential diagnosis of splenomegaly, splenic nodules or infiltrates, the usefulness of splenic biopsy in establishing the diagnosis and recall a rare disease, with non-specific presenting symptoms, in which the diagnostic workup is challenging.