Key result
Metastatic lung adenocarcinoma triggers rare ascending aortic thrombus without structural heart disease.
Why the study?
Ascending aortic thrombus is exceedingly rare and has only been reported in lung cancer patients after cisplatin use; data on cases without chemotherapy or structural risk factors are lacking.
Case Report (n=1)
This case highlights that hypercoagulability of malignancy can cause rare in-situ ascending aortic thrombosis in lung cancer patients, even in the absence of structural aortic disease or cisplatin therapy.
Alerts clinicians to rare aortic thrombosis in lung adenocarcinoma without classic risks; leaves open cancer-specific mechanisms and need for prospective validation.
Background: An ascending aortic thrombus is exceedingly rare. Two instances have been reported in the setting of lung cancer, but only after cisplatin use, which is associated with hypercoagulability. We present the first case of a patient with lung cancer who developed an ascending aortic thrombus, without structural risk factors or chemotherapy use. Case: A 60-year-old female with a significant smoking history, presented with several weeks of malaise. A CT chest revealed a 2.2 cm right upper lobe mass. As an outpatient, right hilar lymph node IHC samples via EBUS confirmed TTF-1+ adenocarcinoma. After the procedure, the patient endorsed dyspnea and was advised to go to the ED. Decision‐making: A CTA chest identified a new 2.4 x 1.1 x 1.1 cm thrombus within the proximal aortic arch. No PE or intrapulmonary shunts were identified. A hypercoagulable workup was negative. TTE was without LV thrombus, akinesis or hypokinesis, LA dilation, or intracardiac shunts. A lower extremity ultrasound was negative for DVT. Given the procedural risk, thrombectomy was deferred. The patient was transitioned to enoxaparin, and a repeat CT for resolution is in process. Conclusion: To our knowledge, this is the only case detailing an in-situ ascending aortic thrombus in the setting of lung cancer, without structural risk factors, chemotherapy use, or other hypercoagulable comorbidities. Optimal management for an aortic thrombus and malignant disease is less clear. Clinicians should be vigilant for unusual arterial thromboses in patients with high metastatic burden.
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Mehta et al. (2023) conducted a case report in In-situ ascending aortic thrombus and metastatic lung adenocarcinoma (n=1). Enoxaparin was evaluated. A 60-year-old female with metastatic lung adenocarcinoma developed a rare in-situ ascending aortic thrombus without structural risk factors or prior cisplatin use.
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