A 61-year-old man, with a history of coronary heart disease, dyslipidemia, type 2 diabetes and hypertension, presented one-week medical symptoms with severe and progressive pain both in his feet and heels. The physical exam showed erythematous-violaceous macules on both soles of his feet (Fig. 1) and abdominal bruits during aus cultation. A total aorta CT angiography was performed, which reported parietal vascular calcifications through out its extension associated with mural thrombus (Fig. 2). A biopsy of the skin lesion was carried out and it reported partial obstruction of the light in a medium vessel caused by a picture compatible with cholesterol crystals (Fig. 3). Anticoagulation was initiated and an aortic-iliac endo prosthesis was requested. The patient died from septic shock secondary to hospital-acquired pneumonia while waiting for prosthesis placement.

Figure 1 

Figure 2 

Figure 3 

Shaggy aorta depicts the severe and extremely friable aortic surface degeneration which shows a tortuous and spiculated aspect and multiple atheromatous ulcerated plaques covered by thrombus that form a spiculated pic ture in the walls according to the imaging studies.

The Shaggy aorta syndrome is the association of these findings with peripheral and/or visceral athero embolism.