Dangerous Feather!

A 57-year-old man presented to an outside hospital with episodes of persistent fever. On further history, the patient stated that his current condition started when he "stuck" himself in the back with a "sharp feather" protruding from his sofa 2 weeks before. He underwent transesopheageal echocardiography (TEE) to assess for endocarditis. TEE showed no evidence of endocarditis; however, the midesophageal TEE view showed a large mobile mass in the long axis view of the descending thoracic aorta. On CT imaging of the thoracic aorta, the large mass with attachment just distal to the left subclavian artery was noted. The decision was made that this friable and highly mobile mass needed to be surgically removed because of the high embolic potential of the mass. Pathologic diagnosis of the mass noted it to be composed of thrombus. In this patient, we theorize that there was an infectious process to cause a bacteremia that may have damaged the intima of the aorta and caused seeding with thrombus.