Elsevier

Annals of Vascular Surgery

Volume 25, Issue 8, November 2011, Pages 1140.e17-1140.e21
Annals of Vascular Surgery

Case Report
Thoracic Mural Thrombi: A Case Series and Literature Review

https://doi.org/10.1016/j.avsg.2011.05.030Get rights and content

Thoracic mural thrombi (TMT) are rare but an important source of distal emboli. Treatment options are dynamic, ranging from open, endovascular to conservative therapies. We report two cases of TMT, one successfully treated with thoracic aortic endoluminal stent placement for visceral and peripheral embolization, the second treated conservatively for digital embolization secondary to TMT in the innominate artery.

Section snippets

Case 1

A 44-year-old, Gravida 2 Para 1, woman with a history significant for hypertension and menorrhagia requiring high-dose estrogen therapy presented from an outside hospital with acute chest and epigastric pain and numbness of her right toes. She was in sinus rhythm. Her abdomen was soft and mildly tender without peritoneal signs. Her pedal pulses were palpable bilaterally with motor function intact. Computed Tomography (CT) of the chest demonstrated an (Fig. 1A) aortic thrombus in the ascending

Case 2

A 43-year–old woman, who is a former 1.5-pack-per-day smoker, with a history of diabetes mellitus, hypertension, and menorrhagia was transferred with progressive ischemic pain and discoloration of the fingers of the right hand over the course of 2 weeks. On presentation, she was in sinus rhythm, with equal blood pressure in both upper extremities and with palpable pulses in the ulnar and radial arteries bilaterally. Cyanotic discoloration was prominently noted in all five fingers of the right

Discussion

TMT is an intriguing pathology with a dynamic therapeutic armamentarium. TMT is increasingly recognized as a source of peripheral emboli, either to the viscera, cerebrovascular circulation, or most commonly the lower extremities. TMT characterizes an aortic thrombus in the ascending aorta or its branches or the descending aorta, typically in young people, in the absence of preexisting disease.1 Aortic thrombus of the thoracic aorta most commonly occurs in the transverse aortic arch with a

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    Therefore, the therapeutic strategy for mural masses in the aortic arch should be considered more carefully, and surgical options may be more favorable. Recent reports describe favorable early outcomes of endovascular repair for patients with mural thrombi or tumors.8 However, its long-term outcome has not been fully established, and its usefulness in the management of mural masses remains controversial.

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