Mural Thrombus of Thoracic Aorta: Few Solutions and More Queries

Abstract

Mobile thrombus in descending thoracic aorta in the absence of aneurysm or atherosclerosis (non-aneurismal non-atherosclerotic descending thoracic aorta or NAADTA) is an uncommon finding with potential catastrophic consequences due to the recognised likelihood of visceral and peripheral embolisation. In this issue of EJVES, Tsilimparis et al. contributed to the understanding in this field by reporting on their experience with eight new cases of NAADTA, four managed by conservative therapy (anticoagulation/anti-platelet) and four by surgical/endovascular repair. Nevertheless, even after this valuable update, few solutions and more queries remain in a subject that is demanding to be managed and still is largely unsettled. The large ambiguity in management of NAADTA is certainly due to the extreme rarity of the condition. Whether this is explained by either under-diagnosis or true low prevalence, or both, might be debated. Nevertheless, even with the last imaging improvements (trans-oesophageal echography, magnetic resonance, etc.) that have increased the sensitivity in the detection of NAADTA in recent years, the condition is today still very sporadically observed. Tsilimparis et al. could find only eight NAADTA in an overall experience alongside the last 12 years, and the largest published series included only nine NAADTA cases. Tsilimparis et al. suggested to perform large screening