Acute Myocardial Infarction, Pulmonary Embolism, and a Suspicious Aortic Mass: A Case of Complex Differential Diagnosis and Management

Abstract Introduction Ascending aorta floating thrombus is a rare entity. Without rapid and specific management this condition has potential catastrophic consequences. Case presentation We report the case of a young woman diagnosed with acute ST elevation myocardial infarction (STEMI) and pulmonary embolism (PE) which revealed the existence of a suspicious aortic mass with a high embolic risk. The definite treatment was surgical resection, and the etiology of the mass was confirmed by histopathological examination. In this case, protein C deficiency was the only significant factor predisposing to thrombus formation. Conclusions This case illustrates the importance of performing a rapid and comprehensive cardiovascular evaluation, even when the initial presentation seems to suggest a clear diagnosis. Ascending aortic floating thrombus requires individualized management, and in specific situations a surgical approach is recommended.