Abstract
Occurrence of a mural thrombus in a diseased descending thoracic aorta (atherosclerotic or aneurysmal) is a well-known and commonly encountered vascular entity. However, thrombus formation in a normal appearing descending thoracic aorta (NADTA) is rarely reported in literature so far. We present an unusual case report with a brief literature review of an aortic mural thrombus (AMT) in descending thoracic aorta in a young male. He presented at our center in the emergency department with acute onset abdominal pain and underwent a contrast enhanced CT scan that confirmed mural thrombus in NADTA. He was conservatively managed with anticoagulation therapy. He had a family history of venous thromboembolism (VTE) in his brother, who had experienced two episodes of deep vein thrombosis at the age of 40 years, managed with anticoagulation. The true incidence, prevalence and exact etiopathogenesis of AMT is still uncertain. However, certain predisposing factors have been described in literature. Through this case report, we aim to highlight the significance of increased awareness required among the general surgeons and radiologists for early and correct diagnosis of this condition, to prevent the unforeseen complications of distal organ/acute limb ischaemia and its associated morbidity and mortality.
Highlights
The Virchow’s triad, published by German physician Rudolf Virchow in 1856, described three broad categories of factors- 1
We present an unusual case report with a brief literature review of an aortic mural thrombus (AMT) in descending thoracic aorta in a young male
We aim to highlight the significance of increased awareness required among the general surgeons and radiologists for early and correct diagnosis of this condition, to prevent the unforeseen complications of distal organ/acute limb ischaemia and its associated morbidity and mortality
Summary
The Virchow’s triad, published by German physician Rudolf Virchow in 1856, described three broad categories of factors- 1. Endothelial injury/dysfunction); contributing to thrombosis [1,2] Definite risk factors such as hyper viscosity, coagulation factor mutation (Factor V, Factor II G2021A) or deficiency (antithrombin III, protein C or S), familial dysfibrinogenemia, chronic smoking, nephrotic syndrome, drug abuse, severe trauma/burns, cancer, late pregnancy, steroid/contraceptive use; lead to hypercoagulability and thrombus formation [2]. Delayed diagnosis of this can lead to end organ damage and acute limb ischaemia (ALI) secondary to embolization [3]; resulting in amputation in 13-14% patients while mortality rate stands at 9-12% [4]. Incidences of mural thrombus in a NADTA with no associated significant medical history have been rare
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