Large Free-Floating Intra-Aortic Thrombus

A 56-year-old woman was admitted with chronic chest and back pain with recent exacerbation.Cardiac enzyme levels and ECG were normal.Her history was positive for a patent ductus arteriosus ligation at 13 years of age and a total left mastectomy owing to cancer 4 months earlier.Her son died at 30 years of age as a result of type A aortic dissection.A chest computed tomography revealed a large floating mass inside the descending aorta attached to the aortic wall adjacent to the left subclavian artery (Figure 1).Magnetic resonance imaging showed a 12-cm, well-defined, pedunculated, homogenous mass (Figure 2 and Data Supplement Movie).At operation, a long (11ϫ1.5 cm), pedunculated, well-organized mass attached to an atherosclerotic plaque distal to the left subclavian artery was found (Figure 3).The highly mobile mass and the adjacent aortic wall incorporating the ulcerated atherosclerotic plaque were removed.On microscopic examination, the presence of a thrombus and the atherosclerotic changes of the aortic wall were confirmed.