Floating mass in the aortic arch: An interesting case report

Abstract

The finding of a floating mass in the aortic arch is rare and the management remains controversial. The gold standard for visualization of atheromatic plaque is computed tomography scanning. However, in some patients transthoracic harmonic imaging from a suprasternal window can reliably visualize protruding aortic arch atheromas, thus making an excellent screening test. We report a case of a ruptured floating atheromatous aortic plaque in a 77-year-old man with severe aortic valve stenosis and known coronary artery disease presenting with progressing dyspnea. Both procedures, atheromatic plaque removal and aortic valve replacement, were undertaken during the same surgical operation, which was completed with success and the patient was discharged in a good state of health.<Learning objective: The management of a patient suffering from both aortic valve stenosis and a pedunculated aortic plaque remains a challenge. It seems to be the only way to remove the plaque before replacing the aortic valve in order to avoid a possible embolism. A strong association between aortic stenosis and aortic atherosclerosis has recently been established. Finally, this case emphasizes the importance of suprasternal echocardiographic view in the diagnosis of a pedunculated mass in the aortic arch.>