MASSIVE MURAL AORTIC ARCH THROMBUS.
Abstract
Mural aortic thrombus is a rare pathology that is more frequently seen
in severe atherosclerotic aortic walls, in aneurysms and acute aortic
syndrome(1). However this can be found in patients without aortic
disease, and be responsible for systemic or cerebral emboli. A
54-year-old male was admitted to our institution for syncope and
aphasia, he was found in the street with ethylic intoxication. After
neurological examination mixed type aphasia was observed, cerebral and
supra aortic arteries CT angiography were performed. Cerebral CT showed
focal filling defect of left middle cerebral artery. Supra aortic
arteries CT angiography was completed with toracoabdominal CT because
massive ascending and arch thrombus was found. The thrombus measured 130
x 33 x 15 mm (Figures 1A and 1B and 1C), and covered from mid ascending
aorta to 40 mm distal to the ostium of left subclavian artery. The
patient was referred to our unit for urgent surgical treatment. Surgery
was performed throw median sterntomy, cardiopulmonary bypass with
moderate hypothermic arrest and anterograde cerebral perfusion via right
axillary artery. Longitudinal aortotomy was made and 140 x 30 x 15 mm
thrombus (Figure 2), attached to posterior mid ascending aorta, was
found and resected, the aortic wall did not show any abnormality. The
patient had an eventful recovery and was discharged 9 days later with
oral anticoagulation and aspirin.