Cocaine-Induced Ascending Aortic Thrombus

Aortic thrombosis without coexisting atherosclerosis is uncommon. Sometimes, aneurysms or dissections can predispose to thrombus in the abdominal or thoracic aorta. However, ascending aortic thrombus in a non-aneurysmal, non-atherosclerotic aorta is a rare occurrence. Although arterial thrombosis has been linked with its use, cocaine-associated thrombus of the ascending aorta has been rarely described. We report a young man with regular use of cocaine presenting with constant, burning, left-sided chest pain. He was found to have a large thrombus in a structurally normal ascending aorta. Medical management with therapeutic anticoagulation was started. Despite an interruption of anticoagulation treatment for two months due to non-compliance, the man survived. This unique case highlights the importance of various vascular complications associated with cocaine use, their early recognition, and their treatment.