This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Doughty, R. N. Articles by Webster, M. W.I. Search for Related Content PubMed PubMed Citation Articles by Doughty, R. N. Articles by Webster, M. W.I.

(Circulation. 1998;97:1421-1422.)
© 1998 American Heart Association, Inc.

Images in Cardiovascular Medicine

Systemic Embolism From a Large Ascending Aortic Thrombus

Robert N. Doughty, MD, MRCP, FRACP; David A. Haydock, MBChB, FRACS; John Wattie, MBChB, FRACR; James T. Stewart, MB, MD, MRCP; ; Mark W.I. Webster, MBChB, FRACP

From the Departments of Cardiology (R.N.D., J.T.S., M.W.I.W.), Cardiothoracic Surgery (D.A.H.), and Vascular Radiology (J.W.), Green Lane Hospital, Auckland, New Zealand.

Correspondence to Dr R.N. Doughty, Department of Medicine, University of Auckland School of Medicine, Private Bag 92019, Auckland, New Zealand.

The ascending aorta is increasingly recognized as a source of thromboembolism in patients with stroke. This case describes a 53-year-old man with diffuse atherosclerosis and a large ascending aortic thrombus who presented with pain and pallor of sudden onset in his right hand. Past history included myocardial infarction 11 years earlier, hypertension, and hypercholesterolemia. Before his myocardial infarction, he had smoked 60 to 100 cigarettes per day and more recently was smoking 20 to 30 per day. A left above-knee amputation had been performed 3 years earlier for severe peripheral vascular disease, and 3 months before this presentation he suffered a stroke with left-sided weakness. Physical examination revealed cooled and mottled fingers with heavy tar staining and multiple splinter hemorrhages on the nails of the right hand (Fig 1). Right radial and brachial pulses were palpable, the right ulnar and left femoral arteries were not palpable, and the right femoral pulse was reduced. There was a moderate residual left-sided weakness. Examination was otherwise unremarkable.

View larger version (97K): [in this window] [in a new window]   Figure 1. Patient's right hand 1 week after embolic event, showing multiple splinter hemorrhages and marked tar staining of fingers.

Digital subtraction angiography of the right arm showed occlusions in the mid-ulnar and distal radial arteries. Aortography showed an elongated filling defect in the ascending aorta (Fig 2). Transesophageal echocardiography confirmed a mass arising from the ascending aorta above the aortic valve (Fig 3). At operation, a tongue-shaped mass originating 1 cm above the right and noncoronary commissures of the aortic valve and . . . [Full Text of this Article]