Free floating thrombus in the non-atherosclerotic, non-aneurysmal ascending thoracic aorta: A rare entity

Free floating thrombus (FFT) attached to the healthy aortic wall in ascending aorta is a very rare condition discovered more frequently with introduction of new imaging modalities. One of the main causes of this condition is hypercoagulable conditions and the main manifestations are distal embolisations. Method We report a case of 59 years old male who suffered from acute ishemia of lower limb due to emboli from floating thrombus in ascending thoracic aorta. Embolus in lower limb arteries was detected first by digital substractional angiography and FFT later on by computer tomography. Anticoagulation therapy was started immediately. After surgical removal of embolus in lower leg, hypercoagulable disorder was revealed. On control computer tomography scan, conducted after 10 days, no sign of thrombus in ascedent aorta was seen. Discussion We believe that initial treatment strategy for FFT should be conservative anticoagulate therapy that in many cases would be also the optimal solution, however no studies confirmed this, nor a medical treatment algorithm is suggested.