Clinical implications of the incidental finding of a free-floating thrombus in the internal carotid artery

We present an 81-year old male in whom a routine carotid artery ultrasonographic follow-up examination incidentally revealed a large, free-floating thrombus (FFT) of the right internal carotid artery. This case focuses on the clinical decision-making regarding FFTs, which constitute a rare condition lacking a diagnostic gold standard with few available data concerning optimum treatment and natural course—in particular regarding patients in whom FFT is an incidental finding. We were able to demonstrate the accuracy of carotid artery ultrasonography in the detection as well as follow-up of FFT. Of clinical interest is furtherly a possible partial disappearance by spontaneous re-adhesion or resolution of the FFT.