Aortic free floating thrombus

Aortic floating thrombus (AFT) is a rare form of aortic thrombosis characterized by the presence of thrombus protruding into the aortic lumen which may or may not be connected to the wall by a stalk.

Pathology

Etiology

Aortic free floating thrombus may develop in those without pre-existing disease although it is considered rare to do so, especially in the absence of coagulopathy.

Reported causes include:

• coagulopathy
• steroid use
• trauma
• IV drug use
• heparin-induced thrombotic thrombocytopenia
• rheumatism
• primary endothelial disorders
• iatrogenic
• vasculitides

Radiographic features

CT

CT angiography may be able to accurately show morphology of aortic free floating thrombus. Some studies suggest ².

• narrow base of attachment at CT scan being more frequent in symptomatic patients
• non-calcified insertion site at CT scan being more frequent in symptomatic patients

Treatment and prognosis

Management strategies for aortic free floating thrombus tends to vary with anatomical location as well as on morphological features of the thrombus. Usually a surgical thrombectomy or thrombolysis is considered. 

Complications

• systemic emboli