Thoracic Aortic Mural Thrombus, an Unusual Source of Peripheral Thromboembolism: A Report of two cases

Author(s): Michalis Gionis, Vasiliki Manaki, Georgia Kaiafa, Elisavet Psoma, Christos Savopoulos, Kiriakos Ktenidis.

Background: Mural aortic thrombus with absence of aneurysmatic or atherosclerotic lesion is a rare finding which usually leads to peripheral embolization and visceral damage. Due to a lack of specific guidelines, the optimal therapeutic treatment remains a controversial topic in the literature.

Case Reports: 1st Case: A 79-year-old man presented with thromboembolism to the left kidney, pancreas, spleen, left popliteal and anterior tibial artery from a 5 cm long thrombus of the descending aorta. He was treated conservatively with therapeutic doses of low molecular weight heparin,antiplatelets and iloprost and continued his treatment at home with therapeutic doses of rivaroxaban and cilostazol. Three and six months later during his follow-up there was a significant regression of the thrombus in the patient’s imaging examination, while his clinical condition was ameliorated.He deceased nine months later after being diagnosed with a brain tumor. 2nd Case: A 70-year-old man presented with mural thrombus of the thoracic aorta, pulmonary thromboembolism, splenic and pancreatic infarcts. He received conservative treatment with therapeutic doses of low molecular weight heparin and antiplatelets.He was transferred in the Cardiologic ICU of our Hospital where his clinical condition was ameliorated.

Conclusion: Thoracic aortic thrombosis in a normal non-atherosclerotic aorta is a rare condition that may present with peripheral thromboembolism. An underlying cause should be identified in all cases, as the condition may indicate a hypercoagulable state associated with underlying malignancy. Conservative treatment can offer good therapeutic outcomes in cases where endovascular repair is not suitable.