CTICasesAortic Arch Mobile Thrombus with Splenic Infarct and Concurrent Diverticulitis
Imaging findings
A patient being worked up for pulmonary embolism after near-simultaneous left-upper- and left-lower-quadrant pain instead shows heterogeneous, inflamed splenic enhancement with a splenic artery aneurysm and an occluded branch consistent with infarct, plus a discrete mobile thrombus arising from the lateral/superior aspect of the aortic arch rather than the more typical undersurface origin. No pulmonary embolus is present. Abdominal CTA additionally reveals acute diverticulitis as an unrelated second process, with portal venous gas also noted.
Key takeaways
Aortic arch thrombus can embolize distally to cause splenic or other visceral infarcts, and its origin can be atypical (lateral/superior rather than undersurface); when a patient has more than one acute abdominal process, don't assume they are related -- here the splenic infarct and diverticulitis were confirmed to be independent, unrelated findings.
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