Published online Mar 6, 2021. doi: 10.12998/wjcc.v9.i7.1755
Peer-review started: November 30, 2020
First decision: December 13, 2020
Revised: December 18, 2020
Accepted: December 29, 2020
Article in press: December 29, 2020
Published online: March 6, 2021
Floating thrombus within the thoracic aorta is a rare entity but may cause systemic embolism. The pathogenesis of floating aortic thrombi is not yet fully understood. No definitive guidelines are available for the management of floating aortic thrombus.
We report a 48-year-old patient, without a history of trauma and infection, who presented with sudden severe back pain. A floating thrombus within the aortic arch was found by computed tomography angiography (CTA). No evidence of coagulopathies was found. However, with the assistance of a three dimensional-printed model, this floating thrombus was identified to be caused by occult aortic dissection (AD). Subsequently, an emergency thoracic endovascular repair was performed. The patient’s back pain was rapidly alleviated postoperatively. CTA at 1 year showed no filling defect in the stent-graft and aorta.
Occult AD is a potential factor causing floating aortic thrombi, endovascular stent-graft exclusion may be an optimal therapeutic choice with promising results. Moreover, the combination of CTA and three dimensional-printed models can contribute to the diagnosis and treatment of floating aortic thrombi due to occult AD.
Core Tip: Floating thrombus within the thoracic aorta is a rare but a life-threatening source of systemic emboli. The pathogenesis of floating aortic thrombi is not yet fully understood. Occult aortic dissection is a potential cause of floating aortic thrombus, which is most commonly detected at autopsy. Misdiagnosis may cause repeated recurrence of floating thrombus. We report a floating aortic thrombus caused by occult aortic dissection identified with the assistance of a three-dimensional printed model. Thoracic endovascular repair was the optimal treatment method in this patient, with promising results. Similar cases have not previously been reported.