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Resumen: La presencia de un trombo en el cayado aórtico sin anomalías es inusual, sin embargo, supone un reto para el clínico. Por un lado, su diagnóstico suele ser incidental o secundario a una embolia sistémica y, por otro, no existe consenso para su tratamiento debido a la falta de estudios aleatorizados.Presentamos el caso de un varón de 54 años que ingresó en la unidad de reanimación tras ictus isquémico de la arteria cerebral media izquierda no revascularizable. Una angiografía por tomografía computarizada con contraste evidenció un trombo pediculado de 7 cm en la aorta torácica con origen en la aorta ascendente medio-distal, aparentemente sin otras anomalías. Se realizó extracción completa del trombo y de la membrana en la base de implantación ante la sospecha de un posible síndrome aórtico agudo. El examen histológico confirmó la presencia de fibrina, sin embargo, los estudios de laboratorio no establecieron una causa principal que justificara la formación del trombo. Abstract: Flotant thrombus in the aortic arch without abnormalities is unusual. Arterial embolic disease continues to challenge clinicians. The diagnosis is usually incidental or secondary to a systemic embolism, although there are no randomized controlled trials for consensus as to its treatment.A 54-year-old man was admitted to the critical care resuscitation unit after a nonrevascularizable left middle cerebral ischaemic stroke. CTA with contrast showed a 7-cm pedunculated thrombus in the thoracic aorta originating from the mid ascending aorta and arch, without other abnormalities. Complete removal of the thrombus and complete resection of the basement membrane were performed due to the suspicion of a possible acute aortic syndrome. Histological examination confirmed the presence of fibrin, however, laboratory studies did not establish a main cause that justified the formation of the thrombus.

The anatomy of the upper airways influences the risk of obstructive sleep apnea (OSA). The size of soft tissue structures, such as the tongue, soft palate, and lateral walls of the pharynx, contributes to the pathogenesis of OSA. New lines of treatment for sleep apnea, such as myofunctional therapy (MT), aim to strengthen the oropharyngeal musculature to improve the defining parameters of apnea. The present protocol uses ultrasound imaging to measure the size of the lingual musculature non-invasively and cost-effectively and evaluates the changes in its morphology. Eligible patients include those with OSA who have undergone submental cervical ultrasound and drug-induced sleep endoscopy before starting MT with the AirwayGym app. Follow-up evaluations are conducted at 3 months after beginning treatment. Patients diagnosed with OSA via questionnaires and polysomnography or respiratory polygraphy are evaluated anatomically and functionally using the Iowa Oral Performance Instrument, a tongue digital spoon, somnoscopy, and submental cervical ultrasound to assess their responses to the AirwayGym app. The lingual thickness (mm) and volume (cm3) and the distance between both lingual arteries (mm) are measured. The AirwayGym app helps users and therapists monitor the patient performance of MT. Incorporating submental ultrasound can be a useful non-invasive tool to evaluate OSA and MT.