A Rare Case of Mural Thrombus in Normal Descending Thoracic Aorta with Literature Review

The Virchow’s triad, published by German physician Rudolf Virchow in 1856, described three broad categories of factors1. Hypercoagulability, 2. Haemodynamic changesstasis/ turbulence in blood flow, 3. Endothelial injury/dysfunction); contributing to thrombosis [1,2]. Definite risk factors such as hyper viscosity, coagulation factor mutation (Factor V, Factor II G2021A) or deficiency (antithrombin III, protein C or S), familial dysfibrinogenemia, chronic smoking, nephrotic syndrome, drug abuse, severe trauma/burns, cancer, late pregnancy, steroid/contraceptive use; lead to hypercoagulability and thrombus formation [2]. Delayed diagnosis of this can lead to end organ damage and acute limb ischaemia (ALI) secondary to embolization [3]; resulting in amputation in 13-14% patients while mortality rate stands at 9-12% [4]. Approximately 80-85% of all arterial thrombi and emboli originate due to disturbances in cardiac functions such as atrial fibrillation, valvular abnormalities, prosthetic heart valves, endocarditis, and myocardial infarction. Around 5% of thrombi arise in diseased aorta, related to either atherosclerosis, dissection or aneurysm. The aortic isthmus is more prone to trauma as compared to the rest of the aorta and hence, is the commonest site of thrombus formation [3,5,6]. Incidences of mural thrombus in a NADTA with no associated significant medical history have been rare.