Abstract 1067: Floating Through The Aorta; Aortic Thrombus Takes It Course

Abstract

Background: Aortic thrombus is an uncommon condition that is usually discovered as an incidental finding but in rare cases can be the cause of fatal conditions. The reported incidence of its intramural, pedunculated and floating types. The most common location is reported to be the descending aorta followed by the aortic arch. The pathophysiology remains unclear but possible predisposing factors include atherosclerosis, hypercoagulability disorders, malignancy, dissections, aneurysm, chronic inflammatory states, substance use and chronic steroid use. Treatment can vary from anticoagulation to thrombolysis and surgical removal based on the clinical presentation. Clinical presentation: 48-year-old male with a past medical history of hyperparathyroidism presented with three days of nausea, vomiting and lower abdominal pain. CT abdomen showed pancreatic inflammation and he was admitted for pancreatitis. MRCP was completed to evaluate for organic causes of pancreatitis which revealed left renal infarction. CTA C/A/P was done to evaluate infarction and was found to have large 1.5 x 1.1 x 2.1 cm mural thrombus, partially free-floating in distal thoracic aortic arch/proximal descending segment and focal narrowing at the origin left renal artery presumed to be of embolic origin. He was started on heparin drip for the rest of his hospital course and continued to improve. Hypercoagulable work up was unrevealing for any specific etiologies of the thrombus. Pancreatitis was determined as the presumed cause of thrombus as thromboembolism is a known possible complication of pancreatitis and splenic vein thrombosis may be seen in up to 12% of patients .Surgical intervention was initially considered, however repeat CT angiogram of chest/abdomen prior to discharge showed near resolution of thrombus with stable left renal infarct. He was discharged with apixaban and was recommended to follow-up outpatient. Conclusion: Aortic thrombus is rare due to the constant flow of pressure within the aorta. Early detection and management are crucial to avoid embolization which can lead to end organ dysfunction, limb ischemia, mesenteric ischemia, and stroke. DOAC anticoagulation is a viable and efficient therapy option if surgical intervention is not feasible