PMC9248980_01
Longitudinal axial computed tomographic angiography image revealing a pedunculated aortic mass in the ascending aorta.
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CCTA revealed extensive multivessel coronary artery calcification, including severe proximal left anterior descending artery (LAD) and proximal right coronary artery (RCA) stenosis in addition to an incidental finding of a significant area of hypoattenuation in the ascending thoracic aorta, near the coronary ostia, which was radiographically most likely consistent with a pedunculated aortic thrombus (Figures 1, 2 A-C).
(A-C) Transverse axial images of coronary computed tomographic angiography at different axial levels demonstrate coronary contrast filling defects in the ascending aorta consistent with suspected aortic thrombus (finally determined to be primary aortic fibroelastoma by histopathology).
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CCTA revealed extensive multivessel coronary artery calcification, including severe proximal left anterior descending artery (LAD) and proximal right coronary artery (RCA) stenosis in addition to an incidental finding of a significant area of hypoattenuation in the ascending thoracic aorta, near the coronary ostia, which was radiographically most likely consistent with a pedunculated aortic thrombus (Figures 1, 2 A-C).
(A) Transesophageal view demonstrating a mobile pedunculated aortic mass in the ascending aorta, superior to the aortic valve. (B) The same aortic mass is visualized across an x-plane (perpendicular plane) view of the transesophageal echocardiogram.
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An intraoperative transesophageal echocardiogram (TEE) during elective surgical revascularization scheduled 1 month later still demonstrated a mobile mass in the ascending aorta, which was concerning for a grade 4 mobile atheroma, or thrombus, or an aortic tumor (Figure 3 A, B).
(A) Gross pathology of aortic fibroelastomas: the specimen presented is a part of the ascending aorta. The intimal surface demonstrates multiple papillary areas in different locations, with pink tan to yellowish discoloration with some mild focal calcification consistent with aortic fibroelastoma. (B) Verhoeff-Van Gieson/EVG stain highlights the elastic cores on histopathology images confirming the diagnosis of fibroelastoma. (C, D) Histopathology slides on different magnification scale demonstrate avascular fibroelastic tissue lined by a single layer of cells with multiple branching points, consistent with papillary fibroelastoma.
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A). Although the mass morphologically had the appearance of a sea anemone similar to a myxoma, the histopathology with CD34 and Verhoeff-Van Gieson/EVG stains highlighted the elastic cores confirming the diagnosis of aortic wall fibroelastoma (Figure 4 B-D).