RECURRENT SYSTEMIC EMBOLISM CAUSED BY ATH EROMATOSIS OF THE THORACIC AORTA

Systemic embolism may originate from cardiac abnormalities or atheroma tous lesions of the arteries. Whereas ischemic stroke due to emboli ar ising from the carotid arteries is a well-known phenomenon, the thorac ic aorta came into consideration recently with the widespread use of t he transesophageal' echocardiography. We report on three patients who showed mobile masses moving in the blood stream which originated from atheromatous plaques in the aortic arch in two and in the descending a orta in one of them. These mobile structures could only be demonstrate d by transesophageal echocardiography. All patients had suffered from recurrent episodes of cerebral, visceral or peripheral embolism, two o f them despite the fact, that they were receiving long-term anticoagul ant therapy with coumarins. We discuss clinical implications of this t hromboembolic syndrome; which should be recognized in the diagnostic e valuation of systemic embolism.