The diagnosis of aortic mural thrombus (AMT), excluding concomitant atrial thrombi, was confirmed after an echocardiogram and a cardiac magnetic resonance exam (Fig. 1D). Five days later, she started a vitamin K antagonist. At 4 weeks, a new CTA showed complete resolution of the AMT (Fig. 1E), so the patient was discharged. No thrombotic risk factors were found, and acenocoumarol was stopped after 6 months.

AMT is characterized by sessile or pedunculated aortic thrombi without concomitant aneurysm or dissection. It is a rare and uncommon cause of acute limb ischemia, with an incidence rate of about 0.45% [1]. The most common locations of AMT are the aortic isthmus, descending thoracic aorta, and lower abdominal aorta [2]; other embolic sources must be rapidly excluded. Since it is a rare pathology, the best treatment strategy is unknown, with no consensus [3,4]. In our case, an early CTA reevaluation (not shown) detected a significant change in thrombus size, suggesting an optimal response to medical therapy, avoiding major surgical risks. Emergency clinicians must always be alert to young patients presenting with arterial embolisms and should consider a “zebra” diagnosis if applicable.