Acute Myocardial Infarction Secondary to Idiopathic Ascending Aortic Thrombus.

BACKGROUND

Ascending aortic thrombus causing acute myocardial infarction through coronary ostial occlusion is exceptional, with only 74 cases reported globally, and may mimic acute aortic dissection on imaging.

CASE SUMMARY: A 48-year-old man with no prior history presented with ST-elevation myocardial infarction. Coronary angiography showed near-total right coronary artery ostial occlusion with a right sinus of Valsalva lesion. Echocardiography revealed a mobile aortic root mass. Computed tomography angiography raised concern for Type A dissection. Emergency surgery revealed a 4 × 2-cm organized thrombus with no dissection. Thrombectomy and saphenous vein bypass were performed. Histopathology confirmed organized thrombus; cultures and thrombophilia workup were negative. Discharged on dual-antiplatelet therapy.

DISCUSSION: Idiopathic aortic sinus thrombus can mimic acute aortic syndrome while causing coronary ischemia, potentially as a chronic process with acute decompensation. Surgical excision with revascularization is definitive.

TAKE-HOME MESSAGES: Aortic root thrombus must be included in the differential of unexplained coronary ostial occlusion in young patients. Emergent surgical exploration enables simultaneous diagnosis and treatment.