Acute aortic thrombosis in the ascending aorta after cisplatin-based chemotherapy for esophageal cancer: a case report

Abstract

Background The risk of thrombus development is considered to be increased by malignant tumors and chemotherapy. In addition, thrombosis of the ascending aorta is rare. We report a case of ascending aortic thrombectomy in a patient with esophageal cancer who developed ascending aortic thrombus after starting neoadjuvant chemotherapy, including operative findings and surgical treatment. Case presentation A 63-year-old man with esophageal cancer was administered chemotherapy comprising cisplatin plus 5-fluorouracil. A week after completing 1 cycle of chemotherapy, computed tomography angiography showed acute aortic thrombosis at the ascending aorta. The risk of embolization appeared high because the thrombosis was floating, so we performed emergency ascending aortic thrombectomy. The postoperative course was good and uncomplicated. A month after this surgery, the patient underwent surgery for esophageal cancer. As of 1 year after the cancer surgery, neither cancer nor thrombosis has recurred. Conclusion We describe a case of acute aortic thrombosis in the ascending aorta after cisplatin-based chemotherapy, that was treated by aortic thrombectomy. The treatment strategy should depend on thrombus location and the condition of the patient, but surgical treatment should be considered where possible to achieve better prognosis.

In-Situ Ascending Aortic Thrombus in an Asymptomatic Patient with Metastatic Lung Adenocarcinoma Not On Cisplatin Therapy

“…An in-situ ascending aortic thrombus in the absence of aortic substrate (i.e., dissection, aneurysm, trauma, aortitis, or aortic atherosclerosis) is an extremely rare occurrence, since high laminar ow within this area precludes hemostasis. There are only a handful of case reports that detail aortic thrombosis due to hypercoagulability of malignancy [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] , and within these studies, the majority have occurred in the descending thoracic or abdominal aorta following viscous energy dissipation, and only four cases involve the ascending aorta (Table 1). Of the four cases, two involved primary bronchogenic carcinomas, and both patients had undergone cisplatin chemotherapy, which is believed to promote a prothrombotic state from elevation of von Willebrand factor levels, hypomagnesemia associated vasospasm, and LV dysfunction 18 .…”