Free-Floating Thrombus of the Aorta: A Rare Complication of COVID-19-Induced Hypercoagulability.

Free-floating thrombus (FFT) of the aorta is a rare condition characterized by a nonadherent portion of thrombus floating within the aortic lumen. Hypercoagulability is a well-known complication of COVID-19 infection, and thromboses related to COVID-19-related hypercoagulability commonly present in the form of venous or arterial thrombosis such as deep vein thrombosis (DVT), pulmonary embolism (PE), ischemic stroke, and myocardial infarction. Unfortunately, FFT associated with COVID-19 infection has been rarely reported in the literature. We report the case of a 53-year-old female patient with an unusual presentation of a pedunculated thrombus in the descending thoracic aorta caused by COVID-19-related hypercoagulability. The patient was treated with anticoagulation therapy and did not require invasive procedures. FFT is a rare but potentially catastrophic complication of COVID-19 infection. Rapid diagnosis and treatment are vital to prevent complications like limb ischemia and stroke.

Importance of performing transesophageal echocardiography in acute stroke patients older than fifty.

BACKGROUND: The purpose of this study was to determine the value of transesophageal echocardiography (TEE) in determining the presence of cardiac manifestations that required anticoagulation in patients presenting with acute stroke. METHODS: Of 626 consecutive stroke patients who underwent TEE, 188 patients with no obvious etiology for stroke were subcategorized according to age. TEE results were analyzed for cardiac findings suggestive of a cause for embolic stroke, including complex atheromas in the arch/ascending aorta, patent foramen ovale (PFO), atrial septal aneurysm (ASA), and intracavitary thrombi. Data were analyzed using Fisher's exact test. RESULTS: Of 188 patients, 66% (125/188) were older than 50 years and 34% (63/188) were younger than 50 years. The incidence of complex atheroma was 12.8% (16/125) in patients older than 50 years as compared to 0% (0/63) in patients who were younger than 50 years (P = 0.002). In patients older than 50 years, findings that indicated a need for anticoagulation based on TEE results were found in 22.4% (28/125) (atheroma = 16, PFO = 12, ASA = 5, thrombus = 3, PFO + ASA = 1) compared to 14.3% (9/63) (atheroma = 0, PFO = 5, ASA = 2, thrombus = 2, PFO + ASA = 1) in patients younger than 50 years. CONCLUSIONS: TEE plays an important role in suspected embolic stroke patients of all age groups. Due to the higher incidence of complex atheromas in patients older than 50 years of age, TEE might be of added importance in identifying the candidates who may benefit from anticoagulation.

Pembrolizumab-Induced Sarcoid-Like Reaction: FDG-PET Scan Interpretation in the Era of Immunotherapy.

Immunotherapy has revolutionized the treatment of malignant melanomas. Immunotherapy is associated with multi-system toxicities, which are referred to as immune-related adverse events (irAEs). Positron emission tomography (PET) with fluorodeoxyglucose (FDG) and CT is the preferred imaging modality to monitor disease progression in melanoma. FDG uptake by a sarcoid-like reaction (SLR) can mimic cancer progression, thereby posing a diagnostic and therapeutic dilemma. We present the case of a 39-year-old patient with malignant melanoma on immunotherapy who presented with PET scan findings of adenopathy with increased uptake. This case highlights the challenges in interpreting PET scan in the setting of an SLR.