An 89-year-old woman developed aortic dissection (type B) with unruptured abdominal aortic aneurysm measuring 40 mm. She has treated atrial fibrillation with direct oral anticoagulants (DOAC); then, we switched to antihypertensive therapy and discontinued DOAC. Eight days post-admission contrastenhanced computed tomography showed a new floating mural thrombus (37×27 mm) in the abdominal aortic aneurysm. DOAC was resumed without surgery owing to advanced age and frailty. The new floating thrombus disappeared 3 months later. Drug therapy should be considered for new floating thrombi in aneurysms if they show both low with no echoic areas (AC sign) on echography.
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