Background: Thrombus formation in the aorta mural is exceedingly rare and traditionally associated with aortic pathol., such as aortic dissection or atherosclerosis. With the pandemic, isolated cases have been ascribed to COVID19 as the presumptive cause. Case: A 64 y/o M with PMHx significant for HTN, DM2, and recent diagnosis of COVID19 presented to our hospital complaining of worsening shortness of breath, cough, and persistent fever for the past two weeks since his COVID19 diagnosis. He was hypertensive and tachypneic but otherwise vitally stable. Phys. examination was unremarkable. Initial lab work was notable for elevated D-dimer, 6.31 mg/L. A CT Angiogram of the chest obtained to rule out pulmonary embolism, while neg. for PE, demonstrated an ill-defined low-d. lesion adherent to the wall of the distal aortic arch, measuring about 1.7 cm, possibly an aortic atheroma or aortic thrombus. Decision-making: A decision was made to repeat CTA chest with optimal contrast timing for evaluation of the aortic arch. A mural thrombus abutting the lateral wall of the aortic arch was identified measuring 1.7 x 2.1 cm in addition to a filling defect in the abdominal aorta measuring 9mm, concerning for thrombus. After discussion with the CT surgery team, medical management with anticoagulation was initiated, with plans for repeat imaging in one week to reassess thrombus burden. Hypercoagulable workup including Protein C, S, and Antithrombin were notably neg. Conclusion: The incidence of aortic mural thrombi is estimated at 0.45%. However given the hypercoagulable state and propensity for arterial thrombosis development with COVID19, this is likely to become more common. There have been about five cases reported of aortic mural thrombi developing in patients subsequent to COVID19 diagnosis, with many discovered following peripheral embolization. Given the devastating consequences of peripheral embolization from this location, prompt diagnosis is paramount. Management is still case by case, with aggressive anticoagulation currently favored. Acute awareness of this potential thrombosis could play a significant role in preventing emergent hospitalizations from distal embolization.