Aortic Arch Thrombus Detected by Inter-Arm Blood Pressure and Pulse Discrepancy in a ۷۷-Year-Old Man Presenting with Urinary Retention

Aortic mural thrombus occurring in a non-aneurysmal, non-dissected aorta is a relatively rare entity. The presentation is variable, and aortic mural thrombus may be asymptomatic or present with emboli or ischemia. We present a case of a ۷۷-year-old man admitted with urinary retention, who was found on examination to have a significant inter-arm blood pressure difference and a reduced right radial pulse. Computed tomography angiography (CTA) was performed and identified the presence of an aortic arch mural thrombus extending into the brachiocephalic trunk, left common carotid artery, and left subclavian artery. No dissection or aneurysm was detected. As there was no evidence of emboli, distal embolization, or ischemia, the patient was treated with anticoagulants. Three months later, the patient remains well with resolution of the radial pulse and inter-arm blood pressure difference; however, repeat CTA was refused, and resolution of the thrombus could not be confirmed. This case highlights the importance of careful general examination in patients presenting with non-vascular complaints and suggests conservative anticoagulation as a treatment modality for aortic mural thrombus in the absence of emboli or ischemia.

کلیدواژه ها:

aortic arch pathology ، blood pressure asymmetry ، systemic arterial stenosis