Conclusions
PFEs of the aortic wall are exceptionally rare and can be found accidentally or show symptoms of cerebral or cardiac ischemia. The diagnosis is particularly difficult mainly due to the lack of experience of the operators. TTE/TEE is the method of choice for their diagnosis while CT scan or MRI can be helpful in the diagnostic doubt. Surgical resection, where possible, is mandatory due to the risk of embolism and is generally low risk surgery. Our case highlights how clinical suspicion should be placed even when the mass is in such atypical positions.