Ascending Aortic Thrombus With Peripheral Embolization

Thoracic aortic mural thrombi are rare in clinical practice, especially in non-aneurysmatic or non-atherosclerotic vessels. They are typically located in the descending aorta, and less frequently in the aortic arch, abdominal aorta, and ascending aorta. Although they are a rare cause of arterial embolization, this is their main manifestation. We present the case of a 48-year-old man, with no cardiovascular risk factors or history of trauma, who presented with acute arterial ischemia of the right upper limb. From the initial investigation, we highlight the presence of a pedunculated mass in the distal portion of the ascending aorta with signs of instability. Due to the risk of additional embolization, the patient was submitted to urgent surgery, with excision of the aortic defect, implantation of a tubular prosthesis as well as thrombo-embolectomy of the right brachial artery. The etiological evaluation of mural aortic thrombi is challenging and implies the exclusion of some prothrombotic conditions known to predispose to arterial thrombosis. This is a rare case that emphasizes the importance of considering the aorta as a possible source of peripheral embolization, even when there is no significant atherosclerotic or aneurysmatic disease.