Presentation
Inferior STEMI. Mass on the coronary cusp of aortic valve seen on a TOE. Dissection vs. thrombus.
Patient Data
There is a hypodense lesion measuring up to 1.7 cm in diameter within the non-coronary aortic cusp consistent with a thrombus. The adjacent leaflet is thickened towards its annular attachment. The coronary aortic cusps are free of thrombus and the origin of the right and left main coronary arteries opacify normally. No coronary artery calcified plaque identified. Right coronary dominance is present. The thoracic aorta has normal caliber and opacification, with no features to suggest dissection. No mediastinal lymphadenopathy. The lungs demonstrate centrilobular emphysematous changes, particularly within the upper lobes. Bilateral apical scarring also noted. The pleural spaces are clear, airways are normal. No suspicious bony abnormality. Imaged superior abdomen is unremarkable.
Conclusion: thrombus within the non-coronary aortic cusp. No CT features to suggest aortic dissection.
Case Discussion
This case illustrates a thrombus within the non-coronary aortic valve cusp. The thickened adjacent leaflet towards its annular attachment raises the possibility of a previous valvulopathy. This patient was not in a hypercoagulable state or had any known infection process.
Native aortic valve thrombosis is rare.
Possible causes to explain the thrombus are thrombosis as a result of endovascular iatrogenic trauma to the valve endothelium, antibodies related to an autoimmune condition, tumoral related thrombus (marantic endocarditis), and pro-coagulable states (e.g. antiphospholipid syndrome).
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