Floating aortic thrombus

Case contributed by Desiré Ciske Havinga


Post-operative follow-up of a patient presenting with acute limb ischemia

Patient Data

Age: 55 years
Gender: Female

Floating aortic thrombus extends from the inferior wall of the aortic arch just proximal to the origin of the left subclavian artery and extends approximately 37 mm in a spindle-shaped filling defect.

No evidence of distal emboli in the imaged structures. Aortic measurements are within normal limits No cardiomegaly, no intracardiac thrombus.

Right upper lobe volume loss and traction bronchiectasis due to fibrosis. Large hiatus hernia.  

The embolic material was confirmed to be bland thrombus on histology.

Case Discussion

A floating aortic thrombus is a mural thrombus projecting into the aortic lumen.

It is a rare finding in an aorta without other pathology and may present with embolic phenomena or be identified incidentally due to the increased use of CT imaging. 

A cause is frequently not found, however, some cases may be related to a pro-thrombotic state. 

Optimal management is uncertain due to the rare nature of the disease but approaches include anticoagulation, thrombectomy, or insertion of a stent over the thrombus. 

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