The descending thoracic aorta as a source of arterial embolic disease: a case report.

We present a case report of a previously healthy 33-year-old white male with a long history of intravenous drug use, who presented to our institution with bilateral ischemia of his lower extremities, secondary to thromboemboli. Initial surgical intervention included bilateral femoral thrombectomies, right distal popliteal thrombectomy, and left lower extremity fasciotomy for compartment syndrome. Diagnostic evaluation using transthoracic two-dimensional echocardiography failed to demonstrate a cardiac or thoracic source for these thrombi. Transesophageal echocardiography did demonstrate a mural thrombus of the proximal descending thoracic aorta, approximately 2 cm distal to the origin of the left subclavian artery, at the position of the ligamentum arteriosum. Confirmation was attained using CT and aortography. The patient was successfully treated with resection and placement of an interposition graft.