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Abstract
During a 28-year period from 1955 to 1983, two cases of massive repetitive arterial
thromboembolism from nonaneurysmal aortic mural thrombus were diagnosed antemortem
and successfully corrected at the University of California, Los Angeles Medical Center.
Within the same time period, 48 cases of nonaneurysmal aortic mural thrombus were
identified in 10,671 consecutive autopsies (0.45% incidence). Eight of these patients
had evidence of distal embolization (17%), and three had major thromboembolic occlusions,
which were considered the proximate cause of death (6%). The latter three patients
represented 9% of autopsy-confirmed deaths from peripheral arterial thromboembolism.
The diagnosis was established in a 49-year-old man and a 51-year-old woman after a
long course marked by recurrent arterial embolization. Despite multiple evaluations,
which included angiography, the diagnosis remained elusive until clinical suspicion
resulted in complete biplane aortographic survey. Although the morphologic characteristics
of this lesion are quite striking, subtle angiographic changes and lack of familiarity
with the clinical presentation contribute to the difficulty and infrequency of diagnosis.
This unique lesion comprises an important segment of the so-called cryptogenic sources
of arterial embolization and can be corrected by a definitive surgical procedure.