Primary aortic thrombus in young: a rare site, a novel treatment.

To cite: Raghu TR, Agrawal N, Hegde M, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2013-010304 DESCRIPTION A 35-year-old man previously asymptomatic, nonsmoker presented with a history of acute onset severe ischaemic pain, paraesthesia and pulselessness involving the left upper limb from the axillary artery distally since 3 days, not preceded by fever or chest pain. ECG was normal and transthoracic echocardiogram showed a normally functioning heart with an abnormal mass in the arch of aorta, which could not be characterised adequately. There was no aortic regurgitation. CT aortogram revealed a large, immobile thrombus fixed in the arch of aorta causing subtotal occlusion of the ostium of the left subclavian artery, with the rest of the aorta having no evidence of atherosclerosis or aortitis and the coronaries were normal (figures 1–3). The subsequent workup including analysis for dyslipidaemia, protein C and protein S and antiphospholipid antibody, erythrocyte sedimentation rate, C reactive protein, rheumatoid factor and antinuclear antibodies did not reveal any obvious predisposing factor. There was no historical or investigational evidence suggestive of any malignancy, connective tissue disorder or claudication or any family history of predisposition.