Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 12 4 2018 02 24 171 174 EN Hassan Aghajani Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Shahrooz Yazdani Clinical Research Development Unit, Shahid Rajaei Hospital, Alborz University of Medical Sciences, Karaj, Iran. Mohammad Ghafaripoor Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Zahra Shajari Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2016 02 11 2017 06 21 Thromboembolism occurs commonly in general practice and leads to significant health burden. Apart from cardiac sources, aortic atherosclerotic plaques contribute considerably to thromboembolism. A 63-year-old diabetic hypertensive woman referred to our center due to exertional chest pain unresponsive to optimal medical therapy and underwent coronary angiography. Owing to resistance during guide-wire advancement, an aortography was performed. Aortic arch injection demonstrated a large suspended mass distal to the left subclavian artery with free movement in the descending thoracic aorta. Echocardiography revealed widespread atherosclerotic changes in the aortic arch with a large hypermobile mass. Dual-source multi-slice (2 × 128:256) computed tomography angiography of the whole aorta revealed a large floating mass (in favor of a thrombus) in the distal portion of the arch. The patient underwent coronary artery bypass grafting due to severe coronary artery disease. The intra-aortic mass, which was actually a large atherosclerotic plaque, was resected at the same session. She was discharged uneventfully and during a 1-year follow-up, she had no embolic events. https://rhythm.tums.ac.ir/index.php/jthc/article/view/489 https://rhythm.tums.ac.ir/index.php/jthc/article/download/489/623