COVID-19-Related Spontaneous Aortic Arch Thrombus With Delayed Embolization

Abstract

Presentation of a 62-year-old man with baseline chronic obstructive pulmonary disease admitted to the hospital with dyspnea and newly diagnosed COVID-19 infection. CT scan of the chest was obtained to rule out pulmonary embolism. This revealed a mural thrombus of the inner curvature of the aortic arch with a floating component. Therapeutic full dose anticoagulation was initiated in combination with close clinical observation and treatment for modest hypoxia. He did well for 1 month and then returned with ischemic rest pain of the right foot. Angiography revealed thrombosis of all 3 tibial arteries in the right leg. Percutaneous mechanical thrombectomy with tissue plasminogen activator injection and angioplasty was performed with success in 1 tibial artery to achieve in line flow to the foot. After continued anticoagulation, the remainder of the tibial arteries autolysed and the aortic thrombus was noted to be resolved 4 months later. A brief pathophysiology discussion is included.

Coexisting portal vein thrombosis and aortic thrombosis in a patient with COVID-19: A case report and literature review

“…It is not clear from the current review which patients will benefit from each treatment modality. Complication following medical/surgical therapy such as delayed embolization after a month was seen in one patient despite being on oral anticoagulation [22] . Data on anticoagulation upon discharge, outcome, and follow-up were not consistently reported, and hence a conclusion on the optimum time to follow up imaging and anticoagulation could not be drawn.…”