A case of vanishing aortic thrombus
Published in the Journal of Medical Case Reports, the authors present a case of rapidly disappearing large thrombus in the proximal aorta.

A 39-year-old woman was presented with a history of left lower limb pain for 2 h followed by weakness of left lower limb and then rest angina and profuse sweating for 2 h. All symptoms occurred over a time period of 6 - 7 h. The patient also had irrelevant speech for 1 h prior to admission. Patient was diabetic for past 1 year on irregular medication.

Cardiovascular system examination otherwise was not significant. Neurological examination revealed flaccid paralysis of left lower limb with gross power 2/5 at hip and knee, sluggish left ankle and knee jerks with left plantar extensor. ECG revealed ST elevation in inferior leads. 2D echo demonstrated a large mass of 2 × 2 cm in the aortic sinus close to the right coronary ostium which was partially mobile.

There was another 1 × 1 cm thrombus in the descending aorta just distal to left subclavian artery which was also mobile. She was immediately taken for CT aortogram and CT of brain. Surprisingly CT aortogram did not reveal any mass/thrombus right from the heart to the middle of superficial femoral artery bilaterally. Thrombus had probably embolized during transit. CT of brain revealed a fresh infarct in the right frontal parasagittal region.

Repeat 2D echo did not reveal any thrombus. Meanwhile, patient became unstable and developed third degree atrioventricular (AV) block and cardiogenic shock. Patient was taken for coronary angiogram which revealed a totally occluding thrombus in the distal right coronary artery.

Patient underwent thrombosuction and primary plain old balloon angioplasty (POBA) under temporary pacemaker support with stabilization of cardiovascular parameters. Routine investigations revealed a normal hemogram and erythrocyte sedimentation rate was 40 mm/h.

Renal and liver function tests were normal. Lipid profile revealed low high-density lipoproteins of 24 mg/dL. Thyroid function test and serum homocysteine levels were normal. C-reactive protein (CRP) was highly raised 11.1 mg.

Patient could not afford for another thrombophilia workup. She was started on heparin and later switched to warfarin, double antiplatelets, statin, beta blocker and ACE inhibitors. Patient was discharged 1 week after admission.

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