Image Diagnosis: Aortic Thrombus in Severe Hypercortisolemia

A 42-year-old man was admitted to our internal medicine service after being found to have an aortic thrombus. The patient presented to his primary care practitioner many days earlier with cough, dyspnea, lower extremity swelling and weakness. He was given antibiotics but did not improve, prompting evaluation for pulmonary embolism. A computed tomography scan of his chest showed extensive nonocclusive aortic thrombus extending from the aortic arch to proximal to the celiac artery (Figures 1 and and2).2). The scan also showed a large 8.4 cm × 6.3 cm heterogeneous right adrenal mass (Figures 2 and and3)3) with internal calcifications and large retroperitoneal and mesenteric nodes with omental caking, indicating metastases