The Warren Alpert Medical School of Brown University, Providence, USA.
The Norman and Rosalie Fain Health Centers, 164 Summit Ave, Providence, RI, 02906, USA.
J Med Case Rep. 2024 May 11;18(1):243. doi: 10.1186/s13256-024-04515-1.
An ascending aortic thrombus is exceedingly rare. Two instances have been reported in the setting of lung cancer, but only after cisplatin use, which is associated with hypercoagulability. We present the first case of a patient with lung cancer who developed an ascending aortic thrombus without structural risk factors or chemotherapy use.
A 60-year-old white female with significant smoking history presented with several weeks of malaise. A chest computed tomography scan revealed a 2.2-cm right upper lobe mass. As an outpatient, right hilar lymph node immunohistochemistry (IHC) samples via endobronchial ultrasound confirmed thyroid transcription factor-1 adenocarcinoma. After the procedure, the patient endorsed dyspnea and was advised to go to the emergency department. A chest computed tomography angiography identified a new 2.4 × 1.1 × 1.1 cm thrombus within the proximal aortic arch. No pulmonary emboli or intrapulmonary shunts were identified. A hypercoagulable workup was negative. Transthoracic echocardiogram was without left ventricular thrombus, akinesis or hypokinesis, left atrial dilation, or intracardiac shunts. A lower extremity ultrasound was negative for deep vein thrombosis. Given the procedural risk, thrombectomy was deferred. The patient was transitioned to enoxaparin, and a repeat computed tomography for resolution is in process.
To our knowledge, this is the only case detailing an in situ ascending aortic thrombus in the setting of lung cancer, without structural risk factors, chemotherapy use, or other hypercoagulable comorbidities. Optimal management for an aortic thrombus and malignant disease is less clear. Clinicians should be vigilant for unusual arterial thromboses in patients with high metastatic burden.
升主动脉血栓极为罕见。有两例报告发生在肺癌患者中，但均在顺铂使用后出现，顺铂与高凝状态有关。我们报告首例肺癌患者发生升主动脉血栓，无结构性危险因素或化疗史。
一名 60 岁白人女性，有大量吸烟史，表现为数周不适。胸部 CT 扫描显示右上叶 2.2cm 肿块。作为门诊患者，经支气管内超声引导的右支气管旁淋巴结免疫组化（IHC）样本证实为甲状腺转录因子-1 腺癌。手术后，患者出现呼吸困难，并被建议去急诊。胸部 CT 血管造影术（CTA）发现近端主动脉弓内有一个新的 2.4×1.1×1.1cm 血栓。未发现肺栓塞或肺内分流。高凝状态检查为阴性。经胸超声心动图未见左心室血栓、无运动或运动不良、左心房扩张或心内分流。下肢超声检查未见深静脉血栓形成。鉴于手术风险，血栓切除术被推迟。患者转为依诺肝素治疗，正在进行重复 CT 以观察血栓溶解情况。
据我们所知，这是唯一一例在肺癌背景下无结构性危险因素、化疗史或其他高凝合并症的原位升主动脉血栓病例。恶性肿瘤合并主动脉血栓的最佳治疗方法尚不清楚。临床医生应警惕转移性负荷高的患者出现不常见的动脉血栓形成。
