Floating thrombi in aortic arch and brachiocephalic artery after blunt impact trauma to chest


Grant Elliott, Dr Michael McCready.

Abstract

Intra-luminal or floating aortic thrombus is a rare clinical finding which carries a life-threatening risk of distal embolization.

We report the case of a 53-year-old female who presented with bilateral leg ischemia one week after a blunt impact trauma to the chest. CT-A revealed systemic emboli with right renal infarctions, and bilateral occlusion of both popliteal arteries. Emergency leg re-vascularisation was performed via open bilateral popliteal embolectomies and fasciotomies, with subsequent below knee amputation of the right leg. CT-A and Transthoracic Echocardiography identified the likely embolic source as two large, intraluminal thrombi attached to the proximal aortic arch and the proximal brachiocephalic artery. No evidence of aortic aneurysm, dissection, or atherosclerosis was present. Such intra-luminal thrombi are particularly rare clinical findings in the aorta in the absence of aneurysm or atherosclerosis.

This case demonstrated anticoagulation as an efficacious treatment for aortic thrombi, with near-complete resolution imaged at 4 weeks.