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Case Reports in Cardiology
Volume 2019, Article ID 8132578, 6 pages
https://doi.org/10.1155/2019/8132578
Case Report

Peripherally Embolizing Aortic Thrombus: The Work-Up, Management, and Outcome of Primary Aortic Thrombus

1Department of Internal Medicine, Beaumont Health System, Royal Oak, MI, USA
2Michigan State University College of Osteopathic Medicine, Lansing, MI, USA
3Department of Cardiovascular Medicine, Beaumont Health System, Royal Oak, MI, USA

Correspondence should be addressed to Ramy Mando; gro.tnomuaeb@odnam.ymar

Received 20 March 2019; Accepted 13 June 2019; Published 2 July 2019

Academic Editor: Ming-Ren Chen

Copyright © 2019 Ramy Mando et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Primary aortic thrombus is an uncommon entity and not frequently reported in the literature. Herein, we discuss the presentation and management of a patient with a primary thoracic mural thrombus. Case Summary. A 46-year-old female with past medical history of tobacco dependence presented for low-grade fever and sudden onset, severe right upper quadrant abdominal pain with associated nausea and vomiting. Computed tomography (CT) revealed an intraluminal polypoid filling defect arising from the isthmus of the aorta projecting into the proximal descending aorta and findings consistent with infarction of the spleen and right kidney. Infectious, autoimmune, hematologic, and oncologic work-up were all unyielding. The patient was started on heparin and later transitioned to apixaban 5 mg twice a day and 81 mg of aspirin daily. She was also counseled regarding smoking cessation. Two months follow-up CT revealed resolution of the thrombus. Patient had no further thromboembolic complications. Discussion. We present a unique case of primary aortic thrombus. To our knowledge, this is the first reported case managed successfully with a NOAC. This diagnosis is one of exclusion and through work-up should be completed. Our aim is to raise awareness of this condition and successful management with apixaban in low-risk patients.