Large Mobile Ascending Aortic Atheroma Presenting With Systemic Embolization: Surgical Resection

Division

East Florida

Hospital

Lawnwood Regional Medical Center & Heart Institute

Document Type

Case Report

Publication Date

10-29-2025

Keywords

aorta, echocardiography, thrombus

Disciplines

Cardiovascular Diseases | Diagnosis | Internal Medicine | Medicine and Health Sciences

Abstract

BACKGROUND: Mobile ascending aortic atheromas are rare but carry high embolic risk, including ischemic stroke and peripheral embolization. Early recognition is crucial to prevent severe cardiovascular complications.

CASE SUMMARY: A 63-year-old woman with hypertension and hypothyroidism presented with abdominal pain, nausea, and vomiting. Computed tomography angiography revealed multiple splenic infarcts and a soft tissue mass in the ascending aorta, initially concerning for localized dissection. Transesophageal echocardiography confirmed a large, mobile atheroma. Given its size, mobility, and embolic events, surgical resection with prophylactic left atrial appendage occlusion was performed.

DISCUSSION: Mobile ascending aortic atheromas, especially with embolization, carry high morbidity. Multimodal imaging is key for diagnosis and risk stratification. Although anticoagulation may suffice for stable lesions, surgery is warranted in high-risk cases.

TAKE-HOME MESSAGES: Suspicion for aortic atheroma should be maintained in unexplained embolic events. Transesophageal echocardiography is essential for diagnosis, and early surgery may be lifesaving in high-risk patients.

Publisher or Conference

JACC Case Reports

Link to Full Text

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