• Tie-Hao Wang, Ji-Chun Zhao, Fei Xiong, and Yi Yang.
• Department of Vascular Surgery, Sichuan University West China Hospital, Chengdu 610000, Sichuan Province, China.
• World J Clin Cases. 2021 Mar 6; 9 (7): 1755-1760.

BackgroundFloating thrombus within the thoracic aorta is a rare entity but may cause systemic embolism. The pathogenesis of floating aortic thrombi is not yet fully understood. No definitive guidelines are available for the management of floating aortic thrombus.Case SummaryWe report a 48-year-old patient, without a history of trauma and infection, who presented with sudden severe back pain. A floating thrombus within the aortic arch was found by computed tomography angiography (CTA). No evidence of coagulopathies was found. However, with the assistance of a three dimensional-printed model, this floating thrombus was identified to be caused by occult aortic dissection (AD). Subsequently, an emergency thoracic endovascular repair was performed. The patient's back pain was rapidly alleviated postoperatively. CTA at 1 year showed no filling defect in the stent-graft and aorta.ConclusionOccult AD is a potential factor causing floating aortic thrombi, endovascular stent-graft exclusion may be an optimal therapeutic choice with promising results. Moreover, the combination of CTA and three dimensional-printed models can contribute to the diagnosis and treatment of floating aortic thrombi due to occult AD.©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.

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