Large Mural Thrombus in the Non-Aneurysmal and Non-atherosclerotic Ascending Aorta: A Case Report

Abstract

BackgroundThe mural thrombus in the ascending aorta is rare, most of which are associated with aneurysm or atherosclerotic lesions, with high risks of causing catastrophic thrombotic events. A mural thrombus in the non-aneurysmal and non-atherosclerotic ascending aorta is exceptionally uncommon.Case PresentationWe reported a large mural thrombus in normal ascending aorta of an asymptomatic patient. Preoperative imaging confirmed the presence of the sessile thrombus located at the left anterior wall of ascending aorta. Given that it had the potential to cause fatal thrombotic complications, surgical removal and segment of ascending aorta replacement were executed. The patient had an uneventful recovery and discharged 14 days after surgery.ConclusionsAnticoagulant is the therapeutic cornerstone of ascending aortic thrombus, but surgery should be performed aggressively when the thrombus is large or floating to avoid severe embolic complications or recurrence.

Case report: Surgical strategies of a giant thrombus from the ascending aorta to the arch

“…The mechanism of thrombosis, in this case, is still unclear; however, regional weakness and inflammation of the endothelium may contribute to thrombosis. Before considering surgical interventions, it is crucial to exclude some conditions such as malignancy, vasculitis, and hypercoagulation (10); hence, results of positron-emission tomography, tumor biomarkers, inflammatory biomarkers, and clotting tests must be obtained before decision-making. Verma et al ( 5) classified mural thrombi of the aorta into four types (type I: the ascending aorta and the arch until the left subclavian artery origin; type II: the descending thoracic aorta up to the celiac artery; type III: between the celiac artery and the most distal renal artery; and type IV: between the lowest renal artery and the aortic bifurcation) based on the location.…”