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Journals
Romanian Journal of Cardiology
Volume 33 (2023): Issue 2 (June 2023)
Open Access
Acute Myocardial Infarction, Pulmonary Embolism, and a Suspicious Aortic Mass: A Case of Complex Differential Diagnosis and Management
Mihai Teodor Bica
Mihai Teodor Bica
,
Claudia Irina Nitu
Claudia Irina Nitu
,
Andrei Iosifescu
Andrei Iosifescu
,
Carmen Cristiana Beladan
Carmen Cristiana Beladan
and
Bogdan A. Popescu
Bogdan A. Popescu
| Jun 30, 2023
Romanian Journal of Cardiology
Volume 33 (2023): Issue 2 (June 2023)
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Article Category:
Case Report
Published Online:
Jun 30, 2023
Page range:
78 - 82
DOI:
https://doi.org/10.2478/rjc-2023-0013
Keywords
ascending aortic mass
,
floating thrombus
,
protein C deficiency
© 2023 Mihai Teodor Bica et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.
Figure 1
ECG trace: sinus rhythm, mild ST elevation, and inverted T waves in DI, aVL, V2-V6 and Q wave in DI, aVL, V4-V6.
Figure 2
2D transthoracic echocardiography – parasternal long axis view. A mobile, irregular mass (arrow), 21/11 mm, attached to the aortic root wall at the level of the left sinus of Valsalva with no impact on the aortic valve.
Figure 3
2D transesophageal echocardiography – mid-esophageal short axis view. The presence of a mobile mass (arrow), irregular, apparently with a pediculated insertion point near the commissure between the aortic noncoronary and left coronary cusps is confirmed.
Figure 4A
Thoracic computed tomography – axial plane. The mural irregular mass (arrow) is located in the aortic root at the left sinus of Valsalva level, in the proximity of the left main ostium. *Courtesy of Dr. Dragoş Caravasile
Figure 4B
Thoracic computed tomography – axial plane. The proximity of the aortic mass (arrow) with the left main ostium is revealed. *Courtesy of Dr. Dragoş Caravasile
Figure 5
Intraoperative image – median sternotomy. The aortotomy allows visualization of the aortic mass (asterisk): multilobed, friable, attached on the aortic wall through a pediculated insertion point near the commissure between noncoronary cusp and left coronary cusp.
Figure 6
Histopathological examination of the mass. Hematoxylin eosin coloration reveals organized thrombus mainly composed of fibrin and platelet cells. *Courtesy of Dr. Liliana Parascan
Figure 7A
Postoperative 2D-transthoracic echocardiography. Parasternal long axis view confirms the absence of the previously described mass, with normal function of the aortic valve.
Figure 7B
Postoperative 2D-transthoracic echocardiography. Parasternal short axis view confirms successful aortic thrombus resection with preserved integrity of the aortic valve and wall.