Digital Embolization From Plaque-Related Thrombus in the Thoracic Aorta: Identification With Transesophageal Echocardiography and Resolution With Warfarin Therapy

A 71-year-old man had painful blue toes after an episode of protracted vomiting. Abdominal, cardiac, and transesophageal ultrasound studies were performed before angiography was considered. A large mobile mass in the proximal descending thoracic aorta, which suggested thrombus, was identified by transesophageal echocardiography. With no further evaluation, anticoagulant therapy with heparin and warfarin was initiated. Three months later, repeated transesophageal echocardiography demonstrated only a tiny vestige of the plaque-related mass. The pain and discoloration of the toes resolved completely. The advantages and disadvantages of the various diagnostic and therapeutic approaches to peripheral embolization are discussed.