Abstract
Ascending aortic thrombus is an uncommon clinical finding, particularly in the absence of significant underlying aortic disease, yet it poses a substantial risk for systemic embolization. We describe a 53-year-old woman with a history of cocaine use who presented with acute neurologic deficits and was found to have a left middle cerebral artery occlusion requiring mechanical thrombectomy. Cross-sectional imaging incidentally identified a 1.8 cm thrombus within the ascending aorta. Anticoagulation with intravenous heparin was initiated, however, her clinical course was complicated by recurrent embolic phenomena, including renal infarction and bowel perforation consistent with mesenteric ischemia. Ongoing deterioration with multiorgan failure precluded surgical intervention, and she ultimately passed away following transition to comfort care. This case illustrates the high embolic potential of proximal aortic thrombi, particularly when large and mobile. Although anticoagulation is frequently used, patients with high-risk features may benefit from surgical consideration. Prompt recognition and individualized management are essential given the potentially fulminant clinical course.
Recommended Citation
Naqvi, MD, Warda; Morgan, MD, Moses; Ali, MD, Muneeba; Haddad, MD, Enad; and Alhassani, MD, Zaineb
(2026)
"Ascending Aortic Thrombus with Systemic Embolization: Implications for Risk Stratification and Management,"
The Medicine Forum: Vol. 27, Article 7.
Available at:
https://jdc.jefferson.edu/tmf/vol27/iss1/7
