Floating thrombus originating from an almost normal thoracic aorta

Abstract

We present a case of floating thrombus originating from an almost normal thoracic aorta in a 54-year-old man who presented with acute arterial occlusion of his left leg. Transesophageal echocardiography (TEE), computed tomography, and magnetic resonance imaging showed two masses in an almost normal aorta after embolectomy for the acute arterial occlusion. Although the embolus was thrombus histologically, malignant tumors could not be ruled out. The masses did not decrease in size after 7 days of anticoagulant therapy, so they were extirpated under cardiopulmonary bypass (CPB) and TEE guidance. Frozen section examination during CPB indicated that there was no evidence of malignancy in the removed mass. TEE played an important role in the diagnosis and surgery of this condition, and it was useful when deciding on a surgical strategy. Because the treatment strategy for this disease remains controversial, further studies are needed.

Asymptomatic floating thrombus in the ascending aorta depicted on four-dimensional computed tomography

“…For example, in one case it was reported that aortic replacement was conducted because malignancy could not be ruled out, 8 while in another case tumor resection alone was performed because examinations of frozen sections did not reveal any malignant findings. 9 There are no established indications for surgery in such cases. We consider that if malignancy cannot be ruled out, aortic replacement could be one of the best methods.…”

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“…Si conseguimos resolver la lesión con éxito, además tendremos una morbimortalidad muy bajas. En el caso de no resolver el problema con las técnicas endovasculares, éstas no entorpecen ni empeoran las técnicas quirúrgicas convencionales, que siempre podremos utilizar (8,9,10).…”

Endovascular Management of a Mobile Thoracic Aortic Thrombus Following Recurrent Distal Thromboembolism

“…The real-time evaluation allows for analysis of both morphologic (ie, sessile vs pedunculated) and dynamic (mobile/floating vs fixed) properties of the thrombus, ultimately providing clues on its embolic potential. [6][7][8][9] In some institutions with the technological capability, MR imaging (MRI)/MR angiography, may also be helpful in this regard, particularly with the additional use of cine-MRI to evaluate the mobility of the thrombus.…”

“…Historically, open surgical intervention was reserved for favorable operative candidates in the setting of concerning morphologic features (ie, mobile thrombi, large thrombi, recurrent embolism, etc) or those that failed to resolve with medical management. 3,6,7 Advancement of endovascular techniques and devices provides a minimally invasive alternative to patients otherwise deemed poor surgical candidates. Reported is a case study and review of current literature surrounding the endovascular management of symptomatic thoracic aortic mobile thrombi (TAMT).…”