Floating Thrombus in Aortic Arch
A 56-year-old man was hospitalized because of pain and numbness in his left hand since he slipped a week earlier. He had no medical history of diabetes or hypertension. He had a thirty pack-year smoking history. In the physical examination, we found that the motor and sensory functions of his left hand were normal. However, his radial artery had no pulsation. His laboratory data, including anti nuclear antibody, anti-neutrophil cytoplasmic antibody, and rheumatoid arthritis factor, were within normal limits. However, the laboratory analysis showed decreased protein C and S concentrations (protein C antigen, 57%; protein S antigen, 19%). The diagnostic work-up to determine the degree of lesion included a computed tomography (CT) angiography, which showed an intraluminal lesion of the left upper extremities vessel. In the CT scan, the deep brachial and radial artery of the left hand was occluded (). Coincidently, we stumbled across a mass lesion on the aortic arch. For the evaluation of the incidental mass lesion, we performed a chest CT scan and transthoracic echocardiography. The ascending aorta and the aortic arch had intact intima and a normal size (). In transthoracic echocardiography, we found a floating mass in the lesser curvature of the aortic arch (). We decided to surgically remove this floating mass because of the risk of peripheral embolization, including thrombectomy for the brachial and radial artery occlusion of the left arm. We inserted arterial cannulation in the left femoral artery. A median sternotomy was performed, a venous cannula was inserted in the RA auricle, extracorporeal circulation was begun, and the central temperature was decreased to 25℃. The patient was then in total circulatory arrest. An incision was made in the aortic arch, and the 3.0-cm intraaortic mass was completely removed (). The mass had no definite stalk, and its attachment site in the aorta was relatively normal. A histopathologic examination revealed the mass to be a fibrin thrombus. We also removed the thrombus of the left upper extremities through the brachial artery. In the postoperative peripheral angiography, the brachial artery and the radial artery showed good blood flow (). One week later, the patient recovered without complications and was discharged on the regimen of warfarin.