Case description
A 51-year-old male was referred to our center due to the incidental finding of a floating thrombus in the thoracic aorta. Two days before he suffered a transient ischemic attack with dysphasia and reduced vigilance. Due to an unclear focus of infection, a CT scan was performed, revealing a floating thrombus formation in the ascending aorta (Figure A and B). Due to two ischemic events in the past, we indicated the need for urgent thrombectomy to avoid further thromboembolic complications. Intraoperative transesophageal echocardiography confirmed the Diagnose of a pedunculated mass, originating from the posterior wall of the ascending aorta (Figure C and D). Open surgical thrombectomy through median sternotomy on cardiopulmonary bypass enabled the retrieval of the 11 x 10 mm thrombus without fragmentation (Figure 1E). The attachement point showed a small endothelian leasion, caused by a ruptured vasa vasorum or sclerotic plaque. To prevent thrombotic recurrence, the site was covered by a pericardial patch plastic (Figure F). Postoperative course was uneventful. Histological examination revealed that the mass was a thrombus. The patient was discharged home under oral anticoagulation with phenprocoumon 7 days after intervention. Tumor screening and extensive coagulation diagnostics yielded no further findings, so that the anticoagulation could be stopped after three months. No recurrence or concomitant vascular embolism was observed during 6 month follow up.