CTICasesFree-Floating Aortic Thrombus with Peripheral Embolization
Imaging findings
Contrast-enhanced CT of the abdomen and lower extremities demonstrates a large, free-floating, adherent thrombus within the lumen of the descending thoracic aorta. More distally, there is acute occlusion of the right profunda femoris artery, as well as abrupt termination and occlusion of the bilateral anterior and posterior tibial arteries, representing acute thromboembolism. The bowel loops also appear abnormal, though no large embolus is visible in the SMA.
Key takeaways
A free-floating thrombus in a non-aneurysmal, minimally atherosclerotic descending aorta is a rare source of systemic arterial embolization. Patients typically present with acute lower extremity ischemia or visceral ischemia. While the thrombus may form on a small atherosclerotic plaque, systemic hypercoagulable states, such as active Crohn's disease, significantly increase the risk of thrombus formation and subsequent peripheral embolic events.
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