Symptomatic Thoracic Aorta Mural Thrombus

Graham Roche-Nagle; Douglas Wooster; George Oreopoulos


Vascular. 2010;18(1):41-44. 

In This Article

Abstract and Introduction


Cases of mural aortic arch thromboses are generally associated with diffuse atherosclerosis of the aortic arch and have primarily been detected in elderly patients. However, the presence of mural thrombi in the aortic arch in young patients without diffuse atherosclerosis has rarely been reported. We describe a case of a hypercoagulable young patient with arterial embolism in whom investigations revealed a mural pedunculated aortic arch thrombosis without clear diffuse atherosclerotic lesions.


The primary source of peripheral arterial embolism (PAE) is cardiac in > 85% of cases. Owing to newer sophisticated imaging techniques, noncardiac sources of PAE have been detected with increasing frequency. Among these noncardiac sources, the aorta has been reported in up to 5% of cases to be the origin of PAE.[1] Mural thrombus in the aorta is commonly observed in the setting of aneurysmal disease and significant atherosclerotic occlusive disease.[2] Although uncommon, symptomatic arterial embolism from either of these aortic disease conditions is recognized.[2] In contrast, mural thrombus with subsequent arterial emboli originating de novo from the nonaneurysmal, nonatheromatous aorta is exceedingly rare.[3] In this case report, we demonstrate the presence of a large, mural thrombus in a morphologically normal aorta as the source of PAE.


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