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Eur J Cardiothorac Surg 2006;30:936
© 2006 Elsevier Science NL

Images in cardio-thoracic surgery

‘Butterfly-shaped’ thrombus in the ascending aorta

Mladen J. Kocicaa,*, Goran Panica, Vesna Lackovicb, Biljana Obrenovic-Kircanskia

a Clinic for Cardiac Surgery, Institute for Cardiovascular Diseases, UC Clinical Centre of Serbia, Belgrade, Serbia
b Institute for Histology and Embryology, Medical Faculty, Belgrade, Serbia

Received 30 June 2006; received in revised form 10 September 2006; accepted 11 September 2006.

* Corresponding author. Address: UC Clinical Centre of Serbia, Institute for Cardiovascular Diseases, Clinic for Cardiac Surgery, 8th Kosta Todorovic St., 11000 Belgrade, Serbia. Tel.: +381 11 3670609; fax: +381 11 3610880. (Email: kocica{at}sezampro.yu). (URL: http://www.ctsnet.org/home/mkocica).

Key Words: Aortic operation • Vascular disease • Thrombosis • Embolism • Pathology

A 61-year-old female was presented with acute aortic syndrome and preoperative diagnostics (Fig. 1 ), confounding in respect to the aortic dissection, penetrating atherosclerotic aortic ulcer or intramural aortic haematoma.


Figure 1
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  		Fig. 1. Preoperative imaging data: (a) trans-esophageal echocardiogram, showing ‘intimal flap’ above sinotubular junction; (b) CT with angiographic contrast showing initial dissecting segment in the antero-medial wall of the ascending aorta with superimposed protruding intraluminal mass; (c) ascending aortography with no angiographic signs of the ascending aortic dissection.

 
Intraoperative and histological findings revealed a pedunculated ‘butterfly-shaped’ thrombus in the macroscopically normal ascending aorta (Fig. 2 ). Postoperative course was uneventful.


Figure 2
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  		Fig. 2. Intraoperative findings: upper tray: magnified view of ‘butterfly-shaped’ ascending aortic thrombus showing attachment of its base to the normal aortic wall (arrows marked); lower tray: ascending aortic thrombus with fresh, fibrinous cap. Trabeculated core contains abundant granulocytes and their fragments (Hematoxylin-Eosin, x100).

 




This article has been cited by other articles:


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 Eur J EchocardiogrHome page
J. O'Sullivan, D. Kerins, and C. Vaughan
Massive thrombus in the aortic arch: a 59-year-old lady with an unknown familial predisposition to vascular thrombosis
Eur J Echocardiogr, January 1, 2008; 9(1): 178 - 180.
[Abstract] [Full Text] [PDF]

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