Journal of the Louisiana State Medical Society
Figure 3: Transesophageal echocardiogram (TEE), upper
esophageal view, 180 o , transverse, confirming the large mass almost completely occluding the ascending aortic root.
Figure 4: Large (1.4 x 1.9 x 0.7 cm) thrombus surgically removed from the aortic root.
aorta however, is considered to be an uncommon source of embolism, 2,6,9 and the most frequent cause of embolism from an aortic source is caused by thrombus superimposed on an atherosclerotic aortic plaque. 2,6 Peripheral and visceral emboli most commonly result from cardiac dysfunction, such as atrial fibrillation, myocardial infarction, endocar- ditis, ventricular aneurysms, and prosthetic heart valves. The most frequent non-cardiac sources are thrombus within proximal aneurysms, ulcerated atherosclerotic plaques, dis- sections, penetrating ulcers, and traumatic lesions. 2,11 In our case, the etiology of thrombus formation was not identified. Aworkup for hypercoagulable and auto-immune
disorders was negative. The absence of any constitutional symptoms and the normal blood tests make any malignant or hematologic disorder a very low possibility. Thromboembolic events in a normal aorta causing systemic embolism in a relatively young patient have been reported in the literature. 2,4,13-15,23,25 However, in these cases there was usually a plausible etiology. Either the patients were taking oral steroidal medications, 15 were heavy ciga- rette smokers, 2,15 were on estrogen therapy, 4 had hyperho- mocysteinaemia 13 or systemic lupus erythematosus, 14 or were taking synthetic progasterons. 2 Transesophageal echocardiography (TEE), 8,22 computed
140 J La State Med Soc VOL 166 July/August 2014
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