Case report: aortic root thrombus presenting with syncope and embolic events

Aortic root thrombus is a rare but potentially life-threatening condition, often associated with systemic embolization or obstruction of coronary arteries (myocardial infarction). The most common reason is a complication of left ventricular assist device (LVAD) implantation, but it may occur in the absence of LVAD, for instance in structural valve disease or prothrombotic disorders (antiphospholipid syndrome, haemolytic diseases, and myeloproliferative disease, making diagnosis challenging.

We report the case of a 47-year-old man with a history of deep venous thrombosis who presented with syncope, anaemia, and new-onset atrial fibrillation. Initial evaluation revealed elevated troponin, cerebral and splenic embolic lesions, and a mobile aortic root mass measuring 2.3 × 1.3 cm. Despite extensive work-up, no autoimmune or haematological disorder was identified. Surgical removal of the thrombus was performed. His postoperative course was complicated by pericardial tamponade requiring drainage but was otherwise favourable. He was discharged on long-term anticoagulation with preserved cardiac function.

Aortic root thrombus may present with systemic embolization in otherwise healthy individuals without identifiable thrombophilia. Early recognition and surgical intervention are essential when thrombus size, mobility, and embolic risk are high.