Ascending aortic ulcerated plaques and thrombi are rare, with an incidence rate of 0.45% [ 1 Sabetai M, Conway A, Hallward G, Bapat V. Ascending aorta thrombus adjacent to a cholesterol-rich plaque as the source of multiple emboli. Interact Cardiovasc Thorac Surg. 2013;16(3):389–90. Google Scholar , 2 Wang B, Ma D, Cao D, Man X. Huge thrombus in the ascending aorta: a case report and literature review. J Cardiothorac Surg. 2019;14(1):157. Google Scholar ]. Presentation is variable but may result in devastating complications including thromboembolism [ 1 Sabetai M, Conway A, Hallward G, Bapat V. Ascending aorta thrombus adjacent to a cholesterol-rich plaque as the source of multiple emboli. Interact Cardiovasc Thorac Surg. 2013;16(3):389–90. Google Scholar , 2 Wang B, Ma D, Cao D, Man X. Huge thrombus in the ascending aorta: a case report and literature review. J Cardiothorac Surg. 2019;14(1):157. Google Scholar ].