Floating Aortic Thrombus Presenting with Acute Ischemic Stroke and Bilateral Lower Limb Ischemia: A Rare Case Report

A floating thrombus in the descending thoracic aorta is a rare but potentially life-threatening source of systemic embolization. It may present with cerebral, visceral, or peripheral arterial ischemia. We report the case of a 50-year-old hypertensive male who presented simultaneously with acute ischemic stroke and bilateral lower limb ischemia. Computed tomography angiography (CTA) demonstrated a floating thrombus in the descending thoracic aorta with embolic occlusion of the right common femoral and left below-knee popliteal arteries. Emergency bilateral thrombectomy was performed with complete restoration of distal flow. Postoperatively, the patient was anticoagulated and recovered fully with neurological improvement and limb salvage. This case highlights the importance of early suspicion, prompt imaging, and timely surgical intervention in rare multi-territorial embolic events.