A case of massive aortic mural thrombus in the absence of atherosclerotic or aneurysmal disease

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Case report: A 45-year-old woman presented to our hospital with increasing dyspnoea. Her past history was of Type-2 Diabetes Mellitus with known microvascular complications, hypertension and recent menorrhagia complicated by iron deficiency anaemia for which she had been commenced on norethisterone three weeks prior. History and clinical examination was highly suspicious of pulmonary embolism.AComputed Tomography Pulmonary Angiography (CTPA) was performed, which confirmed multiple bilateral pulmonary emboli. In addition there was an incidental lobulated filling defect measuring 2.2 x 2.1 x 5.6cm within the descending thoracic aorta arising at the distal aortic arch. Fig 1.a A limited thrombophilia screen was negative and MRI was most suggestive of a bland thrombus without an underlying vessel abnormality and Positron Emission Tomography showed no pathological uptake within the lesion or elsewhere suggesting malignancy. See fig 1 b,c. Given the high risk of systemic emboli a decision was made to proceed to surgical removal. An uneventful replacement of the descending aorta while on cardiopulmonary bypass was performed with a 85mm x 30mm x 25mm thrombus removed. She was discharged home on warfarin. Discussion: An aortic mural thrombus (AMT) that develops in the absence of atherosclerotic or aneurysmal disease is a rare and incompletely understood. In most cases described in the limited literature available there was an undiagnosed hypercoagulable state. In our case there was no atherosclerosis, there was no malignancy and the thrombophilia screen was negative. However, other factors may have contributed like iron deficiency and norethisterone. (Figure Presented).




Haji, K., Heron, V., Davis, R., Nandurkar, D., Kelman, A., & Miller, A. (2016). A case of massive aortic mural thrombus in the absence of atherosclerotic or aneurysmal disease. IJC Heart and Vasculature, 12, 82–84. https://doi.org/10.1016/j.ijcha.2016.07.003

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