Primary Aortic Wall Myxoma Presenting With Recurrent Systemic Embolization

BACKGROUND: Primary aortic wall myxoma is exceptionally rare and may mimic mural thrombus or acute aortic dissection. CASE SUMMARY: A 38-year-old man presented after approximately 12 hours of acute left lower-limb ischemia with concomitant left upper-limb occlusion. Computed tomography angiography showed filling defects in the ascending and descending thoracic aorta. Recurrent embolization after peripheral thromboembolectomy prompted emergency ascending aortic exploration. A friable intramural myxoma was excised with ascending aortic graft replacement; the descending lesion was excluded by staged thoracic endovascular aortic repair while therapeutic anticoagulation was maintained. DISCUSSION: Histopathology confirmed an aortic wall myxoma. The case illustrates the limitations of imaging and an individualized hybrid strategy for suspected multifocal aortic involvement. TAKE-HOME MESSAGES: Recurrent embolization after embolectomy should prompt urgent proximal-source control. Hybrid repair may be considered when anatomy and clinical urgency support it.