CTICasesMobile Thoracic Aortic Thrombus Presenting with Bilateral Cerebellar Infarcts
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Imaging findings
A patient presenting with bilateral cerebellar infarcts was found on workup to have a filling defect in the aortic arch arising along the lesser curve, with adjacent focal atherosclerotic plaque; the rest of the aorta was relatively free of disease. The lesion was mobile, consistent with thoracic aortic mobile thrombus (TAMT).
Key takeaways
Thoracic aortic mobile thrombus is a source of systemic embolization, here presenting with bilateral cerebellar infarcts. Management is debated between anticoagulation, surgery, and stenting; this patient, who had a history of chronic thromboembolic disease on anticoagulation (Xarelto), went to surgery. Histopathology showed chronic, fibrinized 'white clot' unlikely to have resolved with anticoagulation alone.
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