PMC6636506_01
CT of the abdomen and pelvis revealing a mass in the descending thoracic aortia (a) with wedge-shaped infarctions in the right kidney (b) and spleen (c) consistent with an embolic phenomona.
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Computed tomography (CT) completed in the emergency department revealed an intraluminal polypoid filling defect arising from the isthmus of the aorta projecting into the proximal descending aorta and findings consistent with infarctions of the spleen and right kidney (Figures 1(a)-1(c)).
Apical four-chamber view of the heart with no evidence of a source of thrombosis.
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A transthoracic echocardiogram showed no findings to suggest valvular or cardiac source of embolus (Figure 2).
Agitated saline (highlighted in red) in the right heart revealing no crossover into the left heart consistent with no intracardiac shunts.
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An agitated saline bubble contrast study was performed with no evidence of intracardiac shunting (Figure 3).
(a) Transesophageal echocardiogram (transverse view) of a large mass attached to the wall of the descending thoracic aorta. (b) Transesophageal echocardiogram (longitudinal view) of the large mobile mass attached to the aortic wall.
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A transesophageal echocardiogram was then completed and revealed a large echogenic mobile mass attached to the wall of the descending thoracic aorta (Figures 4(a) and 4(b)).
Lower extremity arterial Doppler with significant flow limitations in the left lower extremity consistent with diffuse obstructive atherosclerotic obstructive disease in the left posterior tibial artery, peroneal artery, and anterior tibial artery. The waveforms of the right lower extremity are normal multiphasic Doppler waveforms. In the left extremity, we see dampened monophasic Doppler flow signals in the area of the left posterior tibial artery and dorsalis pedis artery. Diminished pulse volume recordings were seen in the left ankle. Flat line, nonpulsatile flow signals were seen in the digits of the left foot.
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Bilateral lower extremity arterial Dopplers were obtained and revealed severe popliteal-tibial arterial disease in the left lower extremity (Figure 5).
CT obtained for follow-up which reveals resolution of previously noted thrombus of the thoracic aorta.
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The spleen exhibited a lobulated superior margin with volume loss and the right kidney demonstrated a lobulated appearance of the right lower pole compatible with scarring from the previous infarct (Figure 6).