Work

Idiopathic Ascending Aortic Thrombus With Limb Ischemia and Myocardial Infarction in a Young Woman

Year: 2025

Type: article

Abstract: BACKGROUND: Primary aortic thrombus (PAT) is a rare, life-threatening condition that can cause myocardial infarction, stroke, and acute limb or visceral ischemia. CASE SUMMARY: A 48-year-old woman was diagnosed with right-hand ischemia and non-ST-segment elevation myocardial infarction from coronary embolism attributable to a floating PAT in the ascending aorta. She underwent successful surgical resection of the PAT and was discharged on warfarin. DISCUSSION: More cases of PAT are being diagnosed because of improved cardiovascular imaging techniques. Coronary computed tomographic angiography can provide a detailed evaluation of the coronary arteries and the aorta in such patients. Management by a multidisciplinary team is needed to carefully select patients for initial surgical management vs medical therapy with anticoagulation alone. TAKE-HOME MESSAGES: Aortic thrombi are rare in the absence of underlying risk factors such as atherosclerosis, iatrogenic factors, trauma, dissection, aneurysms, aortitis, and hypercoagulable disorders. Surgical treatment should be considered early for proximal, large, free-floating PAT because of the embolic potential to multiple vascular beds, including the coronary circulation.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2025.103519