Author + information
- Received February 2, 2010
- Accepted March 18, 2010
- Published online February 22, 2011.
A 77-year-old man presented with a 6-month history of fatigue and proximal muscle stiffness and aching. He was encephalopathic, and had prominent splinter nail hemorrhages on examination (A). Laboratory evaluation revealed an elevated sedimentation rate (70 mm/h) and hypereosinophilia (10.1 × 106μl). Brain magnetic resonance imaging showed multiple areas of restricted diffusion in bilateral cerebral cortices consistent with multiple emboli (B). A transthoracic echocardiogram was unremarkable. However, a transesophageal echocardiogram revealed extensive mural thrombus on the aortic arch (C, Online Video 1). Although bilateral temporal artery biopsies did not show vasculitis, a positron emission tomography-computed tomography scan revealed vascular inflammation in the aortic arch and its proximal branches (D and E) consistent with giant cell arteritis. Significant large-vessel vasculitis can be associated with de novo thrombus formation in large vessels and its embolic consequences. This case also highlights the role that can be played by transesophageal echocardiography in diagnosing thoracic aortic thrombi.
- Received February 2, 2010.
- Accepted March 18, 2010.
- American College of Cardiology Foundation