CTICasesLarge Mobile Aortic Arch Thrombus
Imaging findings
Chest CT shows a massive, elongated, low-attenuation (30-50 HU) thrombus anchored along the inner curvature of the aortic arch, extending down to the level of the left atrium. The thrombus is highly mobile and eventually embolized to the mesenteric vessels, causing bowel ischemia.
Key takeaways
Mobile aortic thrombi typically form along the aortic isthmus or the undersurface of the arch, likely due to slower flow along the inner curvature. These lesions pose a highly high risk of distal systemic embolization (causing stroke or mesenteric ischemia) and can easily be mistaken for artifact or aortic sarcoma.
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