主动脉漂浮血栓CTA征象分析及其处理策略

Imaging findings and clinical management of aortic floating thrombus detected by CTA

主动脉附壁血栓（Aortic mural thrombus,AMT）主要继发于较严重主动脉粥样硬化、动脉瘤、动脉夹层及动脉炎等,多见于腹主动脉下段,紧贴内壁。主动脉CTA检查中偶尔见到胸腹主动脉甚至升主动脉内部分附壁、部分游离的漂浮血栓,其形成机制尚不明确。本文报道3例主动脉漂浮血栓（Aortic floating thrombus,AFT）的CTA表现及其在随访复查中的变化,希望引起放射科与临床医师的重视,以便及时有效的治疗。

We sought to analyze CT angiography（CTA）findings of aortic floating thrombus（AFT）for raising understanding and making reasonable management selection to improve prognosis.We retrospectively analyzed imaging findings of 3 patients with AFT detected by CTA including location,morphology,size,involved aortic segment,concomitant embolism and dynamic changes that occurred during the follow-up.Speculate the etiology and investigate effective therapy refer to the clinical data and related literatures.Five AFT were detected in the initial CTA study of 3 patients with proximal portion attached to the vessel wall and distal portion that were free floating.One AFT was located in the right anterior wall of the ascending aorta,2 in the aortic isthmus,1 in the thoracic aorta,and 1 in the upper abdominal aorta.The lengths of AFTs were 0.4~5.6 cm（average：2.3cm）.The＇borr＇were 2.0~8.0.3 AFT were located in focal thickened walls,1 in the ostium of intercostal artery,another one in the focal thickened wall of the intercostal artery ostium.Interval increasing in size of the splenic embolism and a new renal segmental artery embolism was noted after 7 days anticoagulation therapy.All the patients had hypercoagulability in different levels while 2 with occult abdominal pain and another one got chest pain.As a conclusion,AFT is a rare form of thrombus.Abnormal coagulation function,aortic disease and abnormal blood flow form are the potential predictors for AFT.CTA scanning can depict the lesions clearly in the first and subsequent examinations and evaluate curative effect.Conservative medication is recommended as the first choice.