Journal of Cardio-Thoracic Medicine

Journal of Cardio-Thoracic Medicine

Aortic Arch Thrombus Detected by Inter-Arm Blood Pressure and Pulse Discrepancy in a 77-Year-Old Man Presenting with Urinary Retention

Articles in Press

Document Type : Case Report

Authors
Elham Keikhah 1
Shabnam Hazrati 1
Roya Imani 2
Hanieh Noroozi 2
Niloofar Deravi 2
Meisam Ghaedi 3
Benyamin Rahimi 4
1 Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2 Shahid Beheshti University of Medical Sciences, Tehran, Iran.
3 Urology and Nephrology Research Center, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
4 Department of Urology, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
10.22038/jctm.2026.96067.1531
Abstract
Aortic mural thrombus occurring in a non-aneurysmal, non-dissected aorta is a relatively rare entity. The presentation is variable, and aortic mural thrombus may be asymptomatic or present with emboli or ischemia. We present a case of a 77-year-old man admitted with urinary retention, who was found on examination to have a significant inter-arm blood pressure difference and a reduced right radial pulse. Computed tomography angiography (CTA) was performed and identified the presence of an aortic arch mural thrombus extending into the brachiocephalic trunk, left common carotid artery, and left subclavian artery. No dissection or aneurysm was detected. As there was no evidence of emboli, distal embolization, or ischemia, the patient was treated with anticoagulants. Three months later, the patient remains well with resolution of the radial pulse and inter-arm blood pressure difference; however, repeat CTA was refused, and resolution of the thrombus could not be confirmed. This case highlights the importance of careful general examination in patients presenting with non-vascular complaints and suggests conservative anticoagulation as a treatment modality for aortic mural thrombus in the absence of emboli or ischemia.
Keywords
Aortic arch pathology
Blood pressure asymmetry
Systemic arterial stenosis
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Journal of Cardio-Thoracic Medicine

Articles in Press, Accepted Manuscript
Available Online from 13 October 2026