Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Clinical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
J Thorac Cardiovasc Surg. 2017 Apr;153(4):791-803. doi: 10.1016/j.jtcvs.2016.12.015. Epub 2016 Dec 22.
To analyze the findings of aortic floating thrombus (AFT) on computed tomography angiography (CTA) for a definitive, timely diagnosis and to select a reasonable management course to improve prognosis.
We retrospectively analyzed imaging findings of 5 patients with AFT detected by CTA, including location, morphology, size, involved aortic segment, concomitant embolism, stent, and dynamic changes during the follow-up.
Seven lesions were detected in the initial CTA studies of the 5 patients: 5 aortic intraluminal floating thrombi (3 patients) and 2 aortic in-stents floating thrombi (ASFTs; 2 patients). One aortic intraluminal floating thrombus was located in the right anterior wall of the ascending aorta and 2 in the aortic isthmus. Interval increasing in size of the splenic embolism and a new renal segmental artery embolism were noted in 1 patient after 7 days anticoagulation therapy. One ASFT was located in the original narrowing part of the aortic stent and another in the overlap of the stents. During the follow-up, some lesions disappeared, whereas the morphology and size varied in others. Four new ASFTs occurred. All the lesions were attached to the focal thickened inner walls of the stents with the free-floating portions along the direction of blood flow.
AFT is a rare, life-threatening disease. Abnormal coagulation function, aortic disease, and history of aortic stent implantation are the potential predictors for AFT. CTA scanning can depict the lesions clearly and evaluate curative efficacy. The therapeutic strategy should be based on the etiology and the patient's physical condition, whereas the preferred treatment is conservative medication.
分析计算机断层血管造影（CTA）检查中发现的主动脉漂浮血栓（AFT），以便明确、及时地诊断，并选择合理的治疗方案以改善预后。
回顾性分析 5 例经 CTA 检查发现的 AFT 患者的影像学资料，包括位置、形态、大小、受累主动脉节段、伴随的栓塞、支架以及随访期间的动态变化。
5 例患者的初始 CTA 研究共发现 7 处病变：5 例主动脉腔内漂浮血栓（3 例）和 2 例主动脉内支架内漂浮血栓（ASFT；2 例）。1 例主动脉腔内漂浮血栓位于升主动脉前壁右侧，2 例位于主动脉峡部。1 例患者在抗凝治疗 7 天后，发现脾栓塞增大，新出现肾段动脉栓塞。1 例 ASFT 位于主动脉支架原狭窄部位，另 1 例位于支架重叠部位。随访期间，部分病变消失，而其他病变的形态和大小发生变化。4 例新出现 ASFT。所有病变均附着于支架局部增厚的内壁，游离部分沿血流方向漂浮。
AFT 是一种罕见的、危及生命的疾病。异常的凝血功能、主动脉疾病和主动脉支架植入史是 AFT 的潜在预测因素。CTA 扫描可以清晰显示病变，并评估疗效。治疗策略应根据病因和患者的身体状况而定，首选的治疗方法是保守药物治疗。
