Floating aortic thrombus in a patient with non-hodgkin's lymphoma

Abstract

Only few cases of aortic thrombus in the absence of atherosclerosis, dissection or aneurysm have been reported in the literature. Aortic thrombus is an uncommon condition even in hypercoagulability states like sepsis, polycytemia, disseminated intravascular coagulation, autoimmune diseases, pregnancy, and cancer (1). We report here computed tomography (CT) findings of a floating aortic thrombus that caused peripheral embolism in a B-cell non-Hodgkin lymphoma patient in the absence of any other predisposing factors. Case reportAn ulcerovegetating mass in the stomach was detected in the upper gastrointestinal endoscopy of a 58-year-old man who had epigastric pain, abdominal distention, weight loss, night sweat and fever complaints. Biopsy revealed CD20 positive, B-cell non-Hodgkin lymphoma.For staging, thoracoabdominal CT was obtained with a 4-channel multidetector CT scanner with a 5 mm slice thickness after i.v. injection of 150 mL of iohexol at a rate of 3.5 mL/s. For thoracic CT the delay time was 25 s, and for abdominal CT the delay time was 60 s. On thoracic CT images, enlarged left supraclavicular, subcarinal, right paracardiac, bilateral internal mammary lymph nodes, thymus invasion, and bilateral pleural effusions were observed. Additionally, a floating thrombus originating from the aortic arch and extending into the descending thoracic aorta was detected. The thrombus was causing partial obstruction of the descending thoracic aorta lumen (Fig. 1). On sagittal reformatted images, it was observed that the thrombus clinged to the aortic wall with a very thin peduncle (Fig. 2). There were no signs of atherosclerosis, aneurysm, dissection, or cardiac thrombus. On abdominal CT scans, a retroperitoneal mass on the left, massive ascites, mesenteric lymphadenopathies and a wedge shaped splenic infarct were observed.Chemotherapy and anticoagulant therapy were immediately started after CT examination. At the 36th hour of chemotherapy and anticoagulant therapy, acute and progressive deterioration of liver and renal function tests and elevation of cardiac biomarkers were detected. Abdominal distension markedly increased, unconsciousness ensued, and peripheral circulation failed. Death occurred at the 40th hour of treatment. DiscussionAortic thrombus may lead to catastrophic consequences as a result of acute or chronic recurrent cerebrovascular, coronary, visceral and peripheral embolism. The mortality rate can be as high as 50%, if not treated. Embolic complications can usually be prevented with early diagnosis and treatment (1, 2). At least 8-65% of aortic emboli originate from the left atrium secondary to atrial fibrillation. Primary thrombus ABSTRACT Aortic thrombus is a rare condition unless there is an underlying wall pathology such as atherosclerosis, aneurysm, dissection, or thrombus within the left heart chambers. It causes visceral or peripheral embolisms, and is fatal, if not treated. These characteristics make early diagnosis and therapy essential. We report here the computed tomography findings of a floa...

Aortic thrombus in patients with severe COVID-19: review of three cases

“…The diffuse pulmonary endothelial damage associated with platelet activation could predispose the formation of micro and macro thrombi, in situ, or with an embolic origin. An aortic thrombus is an uncommon condition even in common hypercoagulability states as sepsis, polycythemia, disseminated intravascular coagulation, autoimmune diseases, pregnancy, and cancer [19], and it is also an uncommon cause of peripheral arterial embolization.…”

Primary Intra-aortic Epstein-Barr Virus–Positive Large B-Cell Lymphoma Presenting as Aortic Mural Thrombosis: An Entity Distinct From Intravascular Large B-Cell Lymphoma

“…Although 2 cases secondary to B-cell lymphoma have been described, histopathological confirmation of neoplastic lymphocytes in the thrombus was not performed. 18,19 In our case, because the neoplastic B cells focally formed a thin layer on the intima of the aorta and its major branches, broad resection from the aortic wall might have been required for antemortem diagnosis. ).…”

Aortic Thrombus in patients with Severe Covid-19. Review of three cases

“…The diffuse pulmonary endothelial damage associated with platelet activation could predispose the formation of micro and macro thrombi, in situ or with an embolic origin [18]. Nevertheless, an aortic thrombus is an uncommon condition even in common hypercoagulability states as sepsis, polycythemia, disseminated intravascular coagulation, autoimmune diseases, pregnancy, and cancer [19], and it is also an uncommon cause of peripheral arterial embolization.…”