Rod-shaped giant floating thrombus in a normal ascending aorta

A 70-year old female presented with an acute thrombosis of toe. Contrasted 3D computed tomography scan revealed a rod-shaped floating mass in a normal ascending aorta (Fig. 1). Urgent thrombectomy was performed successfully under deep hypothermic circulatory arrest (Fig. 2). She fully recovered without any neurological disturbances, and no recurrence of thrombus within 12 months was observed. 320-slice computed tomographic angiography shows a giant floating ascending aortic mass (66 × 18 × 16 mm), with distal edge progressing deeply into the left carotid artery. (A) Axial, (B) sagittal and (C) three-dimensional reconstruction. Intraoperative picture. We chose right axillary artery cannulation to prevent further cerebral embolism. The mass was 7 cm long, the distal edge stuck into the left carotid artery (white asterisk). The mass was attached loosely to the ascending aorta, and it was pulled out easily with forceps. Ascending aorta had no macroscopic signs of atherosclerosis or intramural haematoma. Pathological examination confirmed that the mass was fresh thrombus. Black arrow: head.