The descending thoracic aorta extends from the ligamentum arteriosum to the level of the diaphragmatic hiatus. Although aortic mural thrombus associated with aortic disease, such as aortic aneurysm and aortic dissection, is often seen, . Pain in the chest, jaw, neck or arms. aortic or cardiac diseases, such as aneurysm, penetrating aortic ulcer, severe atherosclerosis, calcication of the thoracic aortic wall, aortic sarcoma, or intracardiac thrombus, were excluded. The aorta is the largest blood vessel in the body, and it delivers blood from the heart to the rest of the body. Thrombus has a constant circumferential . Pramod Kerkar, M.D., FFARCSI, DA. The stent graft prevents blood flow from entering the aneurysm sac, resulting in aneurysm sac thrombosis and stabilization and/or regression. The descending aorta is part of the main artery in your body. Early treatment is therefore crucial; . A floating thrombus in an ascending aorta with normal morphology is very rare, but when it does occur, it may induce a systemic embolism or fatal stroke. Background: A mural thrombus in the descending thoracic aorta frequently leads to distal organ and acute limb ischemia, increasing overall morbidity and mortality.Early diagnosis is imperative as thrombi are usually discovered after end organ damage has taken place. They are typically located in the descending aorta, and less frequently in the aortic arch, abdominal aorta, and ascending aorta. Thoracic aortic mural thrombus (TAMT) of the descending aorta is rare but can result in dramatic embolic events. Although DTAT could be detected incidentally, most cases present with peripheral embolic events, which makes early detection challenging . Appointments 800.659.7822. Descending thoracic aortic thrombus (DTAT) is a rare entity that can lead to systemic arterial thromboembolism, a serious and potentially life-threatening condition.1 Therefore, early detection and treatment are critical for a good prognosis. Use your society credentials to access all journal content and features. The overall risk of rupture at 5 years following the initial diagnosis of descending thoracic or thoracoabdominal aortic aneurysm is estimated to be 20% and is dependent on the aortic size at diagnosis: 0% for aneurysms <4 cm diameter, 16% for those 3 to 5.9 cm, and 31% for aneurysms 6 cm or more. 2008;85(1 suppl):S1 . 295.e13-295.e16. They are dangerous and can break loose to form emboli. Embolism and thrombosis of thoracic aorta. Aneurysms that involve the aorta as it flows through both the abdomen and chest are called thoracoabdominal aortic aneurysms. (1) Aim: The primary endpoint of this study was to evaluate the impact of frozen elephant trunk (FET) and conventional elephant trunk (CET) on aortic mural thrombus. The upper normal limit diameters of the thoracic aorta are 4.0 cm of the ascending portion and 3.3 cm of the descending portion. According to this theory, during the sudden deceleration, the distal transverse arch moves forward while the proximal descending thoracic aorta remains stationary, . Most patients with IMH have Stanford type B (50% to 85%). Thrombus within an aneurysm can mimic aortic dissection. A case of a descending aortic thrombus incidentally detected on computed tomography scan in a 65-year-old female and successfully treated with anticoagulation, preventing subsequent complications. Thrombus in the non-aneurysmal, non-atherosclerotic descending thoracic aorta-an unusual source of arterial embolism. The pathophysiological mechanisms of aortic mural thrombi remain unclear, and there is no consensus regarding therapeutic recommendations. Damage to the walls of the ascending aorta can lead to a life-threatening condition called a thoracic aortic aneurysm. In comparison, thrombus formation in a normal-appearing descending thoracic aorta is reported far less often. Download Free PDF. 2011;41:450-7. mostly located in the descending aorta, and less commonly, in the aortic arch or the abdominal aorta. Thoracic aortic mural thrombi are rare in clinical practice, especially in non-aneurysmatic or non-atherosclerotic vessels. If the lesion is identified as a thrombus before the operation and is located in the descending aorta, abdominal aorta, or its branches, most surgeons prefer to use anticoagulants [2, 3] and implant an endovascular stent in the descending aorta . A Biblioteca Virtual em Sade uma colecao de fontes de informacao cientfica e tcnica em sade organizada e armazenada em formato eletrnico nos pases da Regio Latino-Americana e do Caribe, acessveis de forma universal na Internet de modo compatvel com as bases internacionais. Low blood pressure. La Biblioteca Virtual en Salud es una coleccin de fuentes de informacin cientfica y tcnica en salud organizada y almacenada en formato electrnico en la Regin de Amrica Latina y el Caribe, accesible de forma universal en Internet de modo compatible con las bases internacionales. The presence of thrombi in the atherosclerotic and/or aneurysmatic aorta with peripheral arterial embolism is a common scenario. A 50 years old woman was admitted to the mergency department for pain, coldness, and anesthesia in the the left foot. Approximately 10% to 30% of patients with acute aortic syndrome have IMH. Although the condition is similar to, and was once thought to be a type of . Histopathology Heart -Mural thrombus, infarct. Although they are a rare cause of arterial embolization, this is their main manifestation. Its branches supply blood to your spinal cord, esophagus and other important areas. Differently, IMH thrombus has a smooth surface, represented by the aortic lamella, and may extend longitudinally. Tortuosity of the Descending Thoracic Aorta in Patients with Aneurysm and Type B Dissection. Therefore, in the case of vertebral fractures with aortic thrombus, the possibility of aortic rupture should be ruled out and large aortic rupture may be sealed off due to thrombus. We present the case of a 48-year-old man, with no . The explanted endovascular stent graft demonstrated solid, organized thrombus in the distal portion with less organized thrombotic material proximally (Figure 6 ). Society Members, full access to the journal is a member benefit. The mid-descending thoracic aorta has an average diameter of 2.5 cm (range, 1.6-3.7 cm). Similar to acute aortic dissection, it is classified as Stanford type A (ascending aorta) or B (exclusive involvement of the descending aorta). Continue Reading. ABSTRACT Background: A mural thrombus in the descending thoracic aorta frequently leads to distal organ and acute limb ischemia, increasing overall morbidity and mortality. 1 Therefore, early detection and treatment are critical for a good prognosis. Ann Thorac Surg. Therefore, treatment with rivaroxaban was administered for 3 months, and it . Call 434.924.3627. In addition, yearly composite adverse outcomes . Descending thoracic aortic thrombus (DTAT) is a rare entity that can lead to systemic arterial thromboembolism, a serious and potentially life-threatening condition. Eur J Vasc Endovasc Surg. She had a 25 years history of cigarette smoking, a history of . For the thoracic aorta, a diameter greater than 3.5 cm is generally considered dilated, whereas greater than 4.5 cm would be considered . Open Access | Background Thoracic aortic mural thrombus (TAMT) of the descending aorta is rare but can result in dramatic embolic events. Right atrium (RA) and right ventricle (RV) are dilated with RV hypertrophy ( thin arrow ) and alteration of septal curvature ( arrowhead ). Methods A review of the literature using PubMed was conducted, and all relevant publications describing descending TAMT of the past 15 years were reviewed. Thirty-two publications 2019, World Journal of Surgery. In addition, the high force of blood flow in the thoracic aorta requires a longer seal zone (20 mm) on either end to prevent displacement. His repeat aortogram showed near complete recanalisation of descending thoracic aorta. Endovascular treatment of symptomatic thrombus of the descending thoracic aorta. 2 -6 Recent . They can be diagnosed with imaging techniques . A floating thrombus in the ascending aorta was incidentally discovered in a patient with a descending thoracic aortic aneurysm and a history of alcoholism. This is the American ICD-10-CM version of I71.2 - other international versions of ICD-10 I71.2 may differ. Early treatment is therefore crucial; however, there is not a consensus on ideal initial treatment. Cleveland Clinic is a non-profit academic medical center. Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts. The aorta was replaced with a 20 mm Dacron graft from the distal aortic arch, incorporating the origin of the left subclavian artery, to the mid descending aorta. Introduction. Interactive 5. At 12 months, the graft . Aortic mural thrombi are a rare cause of peripheral arterial embolic events. The secondary endpoint was to investigate the incidence of persistent inflammatory response (IR) in the form of post-implantation syndrome (PIS) or persistent fever without infection focus after FET and CET, respectively, as well . Cases describing thrombus located in the ascending aorta, abdominal aorta, or aortic arch were also excluded. Descending thoracic aortic thrombus (DTAT) is a rare entity that can lead to systemic arterial thromboembolism, a serious and potentially life-threatening condition. Early treatment is therefore crucial; however, there is not a consensus on ideal initial treatment. Gabriele Piffaretti. Fig. Background: A mural thrombus in the descending thoracic aorta frequently leads to distal organ and acute limb ischemia, increasing overall morbidity and mortality. The most proximal portion of the descending thoracic aorta appears slightly dilated and is called the "aortic spindle." . Descending type of thoracic aortic aneurysm refers to weakness and bulging in the wall of a descending thoracic aorta i.e. Although DTAT could be detected incidentally, most cases Anticoagulants include low . At the origination point, it is on the left side of the vertebrae. . During his 7 years of follow-up, he has remained asymptomatic from his pulmonary embolism point of view. 7, 8. the artery remains present in the back portion of individual's chest cavity. This leakage does not occur due to a tear in the aortic wall and, because of this, the condition has been difficult to diagnose until recently. The distal descending thoracic aorta above the diaphragm has an average diameter of 2.4 cm (range, 1.4-3.3 cm). The common causes of anterior cord syndrome are aortic dissection and aortic surgical interventions. The descending aorta (thoracic aorta) is between the arch of the aorta and the diaphragm muscle below the ribs. The patient developed deep venous thrombosis and pulmonary embolism. PROGNOSIS. It runs through your chest to your diaphragm. Early diagnosis is imperative as . A: Axial contrast enhanced magnetic resonance angiography (MRA) shows large proximal descending aortic aneurysm with eccentric thrombus and invasion of adjacent thoracic vertebral body (arrow); B: Sagittal short tau inversion recovery shows large descending aortic aneurysm (white arrow) with high signal within the wall posteriorly (red arrow . Twenty-nine patients (39.2%) with descending TAMT initially underwent thoracic endovascular aortic repair. I71.2 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Difficulty breathing. Therefore the literature is scarce. When enlarged above normal but not reaching aneurysmal definition, the terms dilatation/ectasia can be used 9,12. . Tortuosity of the Descending Thoracic Aorta in Patients with Aneurysm and Type B Dissection. Abstract. Printer-Friendly Version. 116 Hemodynamic characteristics associated with partial thrombosis of the false lumen in patients with chronic aortic dissection of the descending aorta: a 4D flow CMR . In comparison, thrombus formation in a normal-appearing descending thoracic aorta is reported far less often. I74.11 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. There is dilatation of the main pulmonary artery (MPA) compared with the adjacent ascending aorta (AA), with eccentric thrombus in both right and left pulmonary arteries (thick arrow). . A 76-year-old woman with primary polycythemia vera had emboli to both superficial femoral arteries and to a branch of the superior mesenteric artery. We report the case of a young man with prior history of Buerger's disease and marijuana abuse. We describe the case of a 46-year-old woman who had splenic and renal infarctions secondary to embolic showers from a large, mobile thrombus in a morphologically normal proximal descending thoracic aorta. As it descends . Although extremely rare in the descending thoracic aorta, thrombus formation may occur in association with polycythemia vera and should be sought when usual investigations fail to reveal the source. (A) The aortic root is visualized with three sinuses of Valsalva and the origin of the right . IMH converts to acute aortic dissection in 3% to 14% of patients with . Aortic intramural hematoma (IMH) is a condition characterized by blood leaking through the innermost layer of the aortic wall and flowing between the inner and outer walls. Aortic aneurysms that occur in the chest area are called thoracic aortic aneurysms and can involve the aortic root, ascending aorta, aortic arch or descending aorta. Signs and symptoms that a thoracic aortic aneurysm has ruptured or dissected include: Sharp, sudden pain in the upper back that spreads downward. A Case of Thoracic Endovascular Aortic Repair Using Carotid Access with Axillary-Carotid Bypass for Descending Aortic Aneurysm in a Patient with Aortoiliac Occlusive Disease Ann Vasc Dis , 12 ( 1 ) ( 2019 ) , pp. A mural thrombus can be symptomatic or asymptomatic; they are mainly formed in the aorta. Spontaneous unruptured nondissected aortic aneurysms with intramural thrombus can rarely cause anterior cord infarctions. Request PDF | Poster No. Thoracic aortic aneurysm (TAA) represents aneurysmal dilatation of the ascending thoracic aorta, the aortic arch, or the descending thoracic aorta, or a combination of these locations.The most common location for TAA is the ascending aorta, followed by the descending aorta. Kouchoukos NT, Miller DC, et al. The descending thoracic aorta is a part of the aorta located in the thorax.It is a continuation of the aortic arch.It is located within the posterior mediastinal cavity, but frequently bulges into the left pleural cavity.The descending thoracic aorta begins at the lower border of the fourth thoracic vertebra and ends in front of the lower border of the twelfth thoracic vertebra, at the aortic . The formation of a mural thrombus in descending aorta has not been fully explained; however, the principle of Virchow's triad . We report two cases of descending thoracic aorta floating thrombus treated with Bolton Relay thoracic free-flow stent graft. Aortic thrombosis may also occur after trauma. et al. 105 - 108 , 10.3400/AVD.CR.18-00143 Thoracic aortic aneurysm (TAA) is a life-threatening condition that causes significant short- and long-term mortality due to rupture and dissection. The term "aneurysm" is used when the axial diameter is >5.0 cm for the ascending aorta and >4.0 cm for the descending aorta . No treatment guidelines for an aortic thrombus are currently available. SVS Member login. The 2022 edition of ICD-10-CM I71.2 became effective on October 1, 2021. In general, the term aneurysm is used when the axial diameter is >5.0 cm for the ascending aorta and >4.0 cm for the descending aorta 12.. We report a 49-year-old male who presented with chest discomfort for 5&nbsp;days and was admitted to . Thoracic aortic aneurysm, without rupture. A descending thoracic aortic aneurysm is bulging and weakness in the wall of the descending thoracic aorta, located in the back of the chest cavity. Thoracic aortic thrombus is a rare pathology that usually originates from an atherosclerotic aortic wall lesion or an aortic aneurysm and is a potential source of visceral, cerebral and . We describe the case of a 46-year-old woman who had splenic and renal infarctions secondary to embolic showers from a large, mobile thrombus in a morphologically normal proximal descending thoracic aorta. Schedule Online. The patients had symptoms of lower limb ischemia; they underwent preoperative angiography and CTscan, then we proceeded with endovascular exclusion of the thrombus from the systemic circulation. The mural thrombus is usually located in the abdominal aorta, but, albeit infrequently, it can occur in the thoracic aorta. Mural thrombi can arise in normal arteries or within aneurysms. 2014). Early diagnosis is imperative as . Mural thrombus is basically a blood clot that is formed in the blood and is attached to the lining of a chamber of the heart or the wall of a blood vessel. Thoracic aortic aneurysms are less common than aneurysms of the abdominal aorta. Primary thrombosis of the aorta without aneurysm is uncommon. . Thrombus formation in a morphologically normal aorta, however, is a rare event. Loss of consciousness. In our case, these measurements are above the normal limit but not reaching the size to be . Background: Thoracic aortic mural thrombus (TAMT) of the descending aorta is rare but can result in dramatic embolic events. We report a case of anterior spinal cord syndrome due to aneurysm of the thoracic aorta with a mural thrombus. The 2023 edition of ICD-10-CM I74.11 became effective on October 1, 2022. Injury of the isthmus portion of the aorta is more common than the involvement of descending aorta in ATAI . Mural thrombus is usually attributed to systemic hypercoagulability, as summarized in a series of 30 autopsies. 13.1 Segments of the thoracic aorta. IMH and PAU can progress fatally . He presented visceral infarctions due to descending thoracic aortic mobile pedunculated thrombus with complex atherosclerosis. Causes of mural thrombus. Thoracic Endovascular Aortic Repair (TEVAR) is performed by placing a covered stent graft into the descending thoracic aorta via transfemoral access. Aneurysm is defined as dilatation of the aorta of greater than 150% of its normal diameter for a given segment. Mural thrombus was located in the thoracic aorta in ten patients (52 %) and in the abdominal aorta in nine (48 %) (Verma et al. Moreover, CT angiography revealed a mural thrombus (4 mm 6 mm) in the arch of the ascending aorta (Figure 1A, left panel) and a free-floating thrombus (3.5 mm 25 mm) in the distal thoracic aorta (Figure 1A, right panel). Background: A mural thrombus in the descending thoracic aorta frequently leads to distal organ and acute limb ischemia, increasing overall morbidity and mortality. Although DTAT could be detected incidentally, most cases present with peripheral embolic events, which makes early detection challenging. Download. [ 6] Although most thoracic thrombi are seen with atherosclerotic . Article CAS Google Scholar Fayad ZY, Semaan E, Fahoum B, Briggs M, Tortolani A, Ayala M. Aortic mural thrombus in the normal or minimally atherosclerotic aorta. Ann Vasc Surg, 36 (2016), pp. The normal aortic diameter varies based on age, sex, and body surface area.