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Acute Myocardial Infarction, Pulmonary Embolism, and a Suspicious Aortic Mass: A Case of Complex Differential Diagnosis and Management

Romanian Journal of Cardiology
Volume 33 (2023): Issue 2 (June 2023)
By:
Open Access
|Jun 2023

Figures & Tables

Figure 1

ECG trace: sinus rhythm, mild ST elevation, and inverted T waves in DI, aVL, V2-V6 and Q wave in DI, aVL, V4-V6.
ECG trace: sinus rhythm, mild ST elevation, and inverted T waves in DI, aVL, V2-V6 and Q wave in DI, aVL, V4-V6.

Figure 2

2D transthoracic echocardiography – parasternal long axis view. A mobile, irregular mass (arrow), 21/11 mm, attached to the aortic root wall at the level of the left sinus of Valsalva with no impact on the aortic valve.
2D transthoracic echocardiography – parasternal long axis view. A mobile, irregular mass (arrow), 21/11 mm, attached to the aortic root wall at the level of the left sinus of Valsalva with no impact on the aortic valve.

Figure 3

2D transesophageal echocardiography – mid-esophageal short axis view. The presence of a mobile mass (arrow), irregular, apparently with a pediculated insertion point near the commissure between the aortic noncoronary and left coronary cusps is confirmed.
2D transesophageal echocardiography – mid-esophageal short axis view. The presence of a mobile mass (arrow), irregular, apparently with a pediculated insertion point near the commissure between the aortic noncoronary and left coronary cusps is confirmed.

Figure 4A

Thoracic computed tomography – axial plane. The mural irregular mass (arrow) is located in the aortic root at the left sinus of Valsalva level, in the proximity of the left main ostium. *Courtesy of Dr. Dragoş Caravasile
Thoracic computed tomography – axial plane. The mural irregular mass (arrow) is located in the aortic root at the left sinus of Valsalva level, in the proximity of the left main ostium. *Courtesy of Dr. Dragoş Caravasile

Figure 4B

Thoracic computed tomography – axial plane. The proximity of the aortic mass (arrow) with the left main ostium is revealed. *Courtesy of Dr. Dragoş Caravasile
Thoracic computed tomography – axial plane. The proximity of the aortic mass (arrow) with the left main ostium is revealed. *Courtesy of Dr. Dragoş Caravasile

Figure 5

Intraoperative image – median sternotomy. The aortotomy allows visualization of the aortic mass (asterisk): multilobed, friable, attached on the aortic wall through a pediculated insertion point near the commissure between noncoronary cusp and left coronary cusp.
Intraoperative image – median sternotomy. The aortotomy allows visualization of the aortic mass (asterisk): multilobed, friable, attached on the aortic wall through a pediculated insertion point near the commissure between noncoronary cusp and left coronary cusp.

Figure 6

Histopathological examination of the mass. Hematoxylin eosin coloration reveals organized thrombus mainly composed of fibrin and platelet cells. *Courtesy of Dr. Liliana Parascan
Histopathological examination of the mass. Hematoxylin eosin coloration reveals organized thrombus mainly composed of fibrin and platelet cells. *Courtesy of Dr. Liliana Parascan

Figure 7A

Postoperative 2D-transthoracic echocardiography. Parasternal long axis view confirms the absence of the previously described mass, with normal function of the aortic valve.
Postoperative 2D-transthoracic echocardiography. Parasternal long axis view confirms the absence of the previously described mass, with normal function of the aortic valve.

Figure 7B

Postoperative 2D-transthoracic echocardiography. Parasternal short axis view confirms successful aortic thrombus resection with preserved integrity of the aortic valve and wall.
Postoperative 2D-transthoracic echocardiography. Parasternal short axis view confirms successful aortic thrombus resection with preserved integrity of the aortic valve and wall.
DOI: https://doi.org/10.2478/rjc-2023-0013 | Journal eISSN: 2734-6382 | Journal ISSN: 1220-658X
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Language: English
Page range: 78 - 82
Published on: Jun 30, 2023
Published by: Romanian Society of Cardiology
In partnership with: Paradigm Publishing Services
Publication frequency: 4 times per year
Keywords:
ascending aortic mass,
floating thrombus,
protein C deficiency
Related subjects:
Medicine,
Clinical medicine,
Internal medicine,
Cardiology,
Pediatrics and juvenile medicine,
Paediatric cardiology,
Surgery,
Cardiac surgery

© 2023 Mihai Teodor Bica, Claudia Irina Nitu, Andrei Iosifescu, Carmen Cristiana Beladan, Bogdan A. Popescu, published by Romanian Society of Cardiology
This work is licensed under the Creative Commons Attribution 4.0 License.

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