Free-Floating Aortic Thrombus: A Case Study and Review of Imagining for a Rare disease

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

A free-floating thrombus (FFT) in the aorta is an exceedingly rare pathology, with only approximately 100 cases reported in the literature, the majority of which involve the aortic arch. Identification of an FFT in the abdominal aorta is even rarer, particularly in patients without identifiable risk factors for thrombus formation. The downstream consequences of FFT can be catastrophic, including peripheral and cerebral emboli. Patients most commonly present with symptoms related to embolic events, requiring rapid diagnosis and treatment to prevent further tissue ischemia. This case study aims to describe the acute presentation of a patient with two symptomatic FFTs in the abdominal aorta, their imaging findings, and the treatment pursued.

We report the case of a 44-year-old female who presented to the emergency department with acute-onset chest and epigastric pain. CT of the abdomen and pelvis revealed two free-floating thrombi within the aorta: one in the distal thoracic aorta near the right ventricle and another just above the renal arteries. The CT also demonstrated evidence of a splenic infarct, believed to be secondary to the free-floating aortic thrombi. Follow-up CTA of the chest confirmed the diagnosis. An MRA was acquired and showed no evidence of underlying malignancy or vasculitis. The patients only risk for thrombus formation was smoking, and her hypercoagulable workup was negative. She was managed medically with Eliquis and followed as an outpatient by hematology. Repeat CTA performed several months later demonstrated a decrease in the size of the two FFTs.

Maintaining suspicion for embolic causes of a patient's presentation, particularly when other etiologies have been ruled out, is important to initiate the workup for a potential FFT. Recognition on CTA of thrombus protruding into the aortic lumen, which may or may not be connected to the vessel wall by a stalk, is essential for the diagnosis of a free-floating thrombus. In our patient, medical management was pursued for treatment of the two FFTs; however, some literature supports surgical intervention as an effective treatment option.

Recognizing the symptoms of an FFT and its associated radiographic findings is crucial for appropriate treatment and the prevention of secondary embolic events. Even in patients without an underlying hypercoagulable state, an embolic origin should be considered when other potential causes of the presenting symptoms have been ruled out.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2129

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