Causes of “idiopathic” aortic thrombus

Abstract

We read with interest the case report by Kolvekar and colleagues [1Kolvekar S.K Chaubey S Firmin R Floating thrombus in the aorta.Ann Thorac Surg. 2001; 72: 925-927Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar] about a floating thrombus in the aorta. They wrote that “there are few reported cases of embolism of thrombus in a nonaneurysmal, effectively normal aorta with no other underlying reason for thrombus formation in the aorta” and speculated that “a local endothelial abnormality was the origin of the problem.” We bring to your attention our report of aortitis presenting as an intraaortic mass and coronary embolus [2Goldman M.H Akl B Mafi S Pastore L Granulomatous aortitis presenting as an acute myocardial infarction in Crohn’s disease.Circulation. 2000; 102: 3023-3024Crossref PubMed Scopus (12) Google Scholar]. Surgical exploration led to successful resection of a pedunculated thrombus. Microscopic examination of the aorta revealed circumferential granulomatous aortitis. There were no other aortic abnormalities, aortic insufficiency, or evidence of arteritis involving other vessels.We would appreciate knowing whether the patient seen by Kolvekar and coauthors underwent an aortic biopsy and whether aortitis was considered in the differential diagnosis. Though mobile thrombi have been documented in the presence of atherosclerotic lesions, there remains little information in regard to other aortic wall abnormalities. We read with interest the case report by Kolvekar and colleagues [1Kolvekar S.K Chaubey S Firmin R Floating thrombus in the aorta.Ann Thorac Surg. 2001; 72: 925-927Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar] about a floating thrombus in the aorta. They wrote that “there are few reported cases of embolism of thrombus in a nonaneurysmal, effectively normal aorta with no other underlying reason for thrombus formation in the aorta” and speculated that “a local endothelial abnormality was the origin of the problem.” We bring to your attention our report of aortitis presenting as an intraaortic mass and coronary embolus [2Goldman M.H Akl B Mafi S Pastore L Granulomatous aortitis presenting as an acute myocardial infarction in Crohn’s disease.Circulation. 2000; 102: 3023-3024Crossref PubMed Scopus (12) Google Scholar]. Surgical exploration led to successful resection of a pedunculated thrombus. Microscopic examination of the aorta revealed circumferential granulomatous aortitis. There were no other aortic abnormalities, aortic insufficiency, or evidence of arteritis involving other vessels. We would appreciate knowing whether the patient seen by Kolvekar and coauthors underwent an aortic biopsy and whether aortitis was considered in the differential diagnosis. Though mobile thrombi have been documented in the presence of atherosclerotic lesions, there remains little information in regard to other aortic wall abnormalities.