Successful Conservative Treatment of a Complicated Aortic Thrombus in a Woman with Factor V Leiden Mutation

Thrombus in the aortic trunk is a rare complication. We report the case of a 63-year-old patient with a factor V Leiden mutation in whom an aortic arch thrombus was discovered accidentally. Conservative treatment was initiated with therapeutic anticoagulation with low-molecular-weight heparin leading to complete thrombus lysis after 3 months but associated shortly after anticoagulation initiation with a large splenic and limited renal infarctions. LEARNING POINTS: Intra-aortic thrombus is rarely diagnosed on routine CT examination. Even a complicated aortic arch thrombus can be successfully treated with conservative anticoagulation. Vascular systemic embolisms are possible after therapeutic anticoagulation is started.