Wang Tie-Hao, Zhao Ji-Chun, Xiong Fei, Yang Yi
Department of Vascular Surgery, Sichuan University West China Hospital, Chengdu 610000, Sichuan Province, China.
World J Clin Cases. 2021 Mar 6;9(7):1755-1760. doi: 10.12998/wjcc.v9.i7.1755.
Floating thrombus within the thoracic aorta is a rare entity but may cause systemic embolism. The pathogenesis of floating aortic thrombi is not yet fully understood. No definitive guidelines are available for the management of floating aortic thrombus.
We report a 48-year-old patient, without a history of trauma and infection, who presented with sudden severe back pain. A floating thrombus within the aortic arch was found by computed tomography angiography (CTA). No evidence of coagulopathies was found. However, with the assistance of a three dimensional-printed model, this floating thrombus was identified to be caused by occult aortic dissection (AD). Subsequently, an emergency thoracic endovascular repair was performed. The patient's back pain was rapidly alleviated postoperatively. CTA at 1 year showed no filling defect in the stent-graft and aorta.
Occult AD is a potential factor causing floating aortic thrombi, endovascular stent-graft exclusion may be an optimal therapeutic choice with promising results. Moreover, the combination of CTA and three dimensional-printed models can contribute to the diagnosis and treatment of floating aortic thrombi due to occult AD.
胸主动脉内漂浮血栓是一种罕见病症，但可导致全身栓塞。漂浮性主动脉血栓的发病机制尚未完全明确。目前尚无针对漂浮性主动脉血栓治疗的明确指南。
我们报告一名48岁患者，无创伤和感染史，突发剧烈背痛。通过计算机断层血管造影（CTA）发现主动脉弓内有一漂浮血栓。未发现凝血功能障碍证据。然而，借助三维打印模型，该漂浮血栓被确定为由隐匿性主动脉夹层（AD）引起。随后，进行了急诊胸主动脉腔内修复术。术后患者背痛迅速缓解。术后1年的CTA显示支架移植物和主动脉内无充盈缺损。
隐匿性AD是导致漂浮性主动脉血栓的潜在因素，血管内支架移植物置入术可能是一种具有良好效果的最佳治疗选择。此外，CTA与三维打印模型相结合有助于隐匿性AD所致漂浮性主动脉血栓的诊断和治疗。
