Clinical picture

At surgery, the mass was localised with intraoperative ultrasound. The aortic adventia was indurated and erythematous at the site of attachment. The mass measured 2 cm by 5 cm and originated from a shallow intimal ulcer. The mass consisted of organising thrombus, and the aortic wall demonstrated acute and chronic inflammation with micro-thrombi in small blood vessels. A strongly positive IgG and IgA anti-cardiolipin antibody assay and a moderately positive IgM assay were subsequently identified, and the diagnosis of anti-phospholipid syndrome made. With acute arterial embolisation, transthoracic echocardiography is commonly used to identify a source, and to plan treatment (anti-coagulant therapy).