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.