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

Abstract

Background: An ascending aortic thrombus is exceedingly rare. Two instances have been reported in the setting of lung cancer, but only after cisplatin use, which is associated with hypercoagulability. We present the first case of a patient with lung cancer who developed an ascending aortic thrombus, without structural risk factors or chemotherapy use. Case: A 60-year-old female with a significant smoking history, presented with several weeks of malaise. A CT chest revealed a 2.2 cm right upper lobe mass. As an outpatient, right hilar lymph node IHC samples via EBUS confirmed TTF-1+ adenocarcinoma. After the procedure, the patient endorsed dyspnea and was advised to go to the ED. Decision‐making: A CTA chest identified a new 2.4 x 1.1 x 1.1 cm thrombus within the proximal aortic arch. No PE or intrapulmonary shunts were identified. A hypercoagulable workup was negative. TTE was without LV thrombus, akinesis or hypokinesis, LA dilation, or intracardiac shunts. A lower extremity ultrasound was negative for DVT. Given the procedural risk, thrombectomy was deferred. The patient was transitioned to enoxaparin, and a repeat CT for resolution is in process. Conclusion: To our knowledge, this is the only case detailing an in-situ ascending aortic thrombus in the setting of lung cancer, without structural risk factors, chemotherapy use, or other hypercoagulable comorbidities. Optimal management for an aortic thrombus and malignant disease is less clear. Clinicians should be vigilant for unusual arterial thromboses in patients with high metastatic burden.