Floating thrombi in aortic arch & 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 lifethreatening 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 intraluminal

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.