Caught Adrift Navigating the Incidental Discovery of a Floating Aortic Thrombus
Document Type
Conference Proceeding
Publication Date
2025
Publication Title
American Journal of Respiratory and Critical Care Medicine
Abstract
Introduction: Floating aortic thrombi (FATs) are rare vascular anomalies often discovered incidentally, yet they pose a considerable risk for systemic embolization. Here, we report a case of an incidentally identified FAT in a patient with a previously unrecognized Factor V Leiden mutation, emphasizing the need for timely multidisciplinary management.
Case Presentation: A 42-year-old woman with a history of epilepsy was transferred to our tertiary care facility following an episode of status epilepticus, necessitating emergent endotracheal intubation, for continuous electroencephalogram (EEG) monitoring. Initial infectious workup, including blood cultures, urinalysis, and respiratory viral panel, returned negative. Her elevated serum troponin levels, without corresponding ST-segment elevation myocardial infarction, and nonspecific ST-T wave changes on ECG prompted a computed tomography angiogram (CTA) to assess for pulmonary thromboembolism. Unexpectedly, the CTA identified an incidental floating thrombus in the descending thoracic aorta.The hypercoagulable workup was sent which identified a heterozygous Factor V Leiden mutation. Notably, she had no prior history of coronary artery disease or thromboembolic events.
Management and Outcomes: A multidisciplinary team, including vascular surgery, cardiothoracic surgery, interventional radiology, and neurology, coordinated her care. She received immediate intravenous heparin, which was later transitioned to apixaban for long-term anticoagulation. Follow-up CTA confirmed complete thrombus resolution, and she achieved full neurological recovery following extubation. Genetic counseling was provided, with family screening recommended.
Discussion: This case emphasizes the significance of thoroughly evaluating incidental FATs, particularly in individuals with underlying genetic predispositions to thrombosis. Prompt anticoagulation and coordinated multidisciplinary care can lead to successful outcomes. Additionally, the case highlights the role of genetic screening in patients with atypical thrombotic events, as identifying inherited thromboembolic disorders influences patient care and offers valuable insights for genetic screening and family counseling.
Volume
211
First Page
A5810
Recommended Citation
Alnabulsi Z, Faizee F, Dado C. Caught adrift navigating the incidental discovery of a floating aortic thrombus. Am J Respir Crit Care Med. 2025;211: A5810. doi: 10.1164/ajrccm.2025.211.Abstracts.A5810
DOI
10.1164/ajrccm.2025.211.Abstracts.A5810
Comments
The American Thoracic Society (ATS) International Conference, May 16-21, 2025, San Francisco, CA.