Right atrial thrombus mimicking myxoma with pulmonary embolism in a patient with systemic lupus erythematosus and secondary antiphospholipid syndrome.
Antiphospholipid syndrome is a well-defined entity that is characterized by spontaneous abortion, thrombocytopenia, and recurrent arterial and venous thromboses. A partially calcified right atrial thrombus mimicking myxoma with recurrent pulmonary embolism has not been previously reported in a patient who also had systemic lupus erythematosus and secondary antiphospholipid syndrome. Herein, we describe the case of a 37-year-old woman with systemic lupus erythematosus and secondary antiphospholipid syndrome who was admitted to the hospital with progressive exertional dyspnea. Ventilation-perfusion scanning showed multiple parenchymal defects in the lungs that portended pulmonary embolism. In addition, the scanning revealed normal regional ventilation. Transthoracic and transesophageal echocardiography showed a right atrial mass that was highly suggestive of myxoma, and the patient subsequently underwent surgery. A histologic examination showed an organized, partially calcified thrombus. Intracardiac thrombus has been rarely reported as a complication of antiphospholipid syndrome. In our patient, the preoperative investigations could not differentiate the partially calcified right atrial thrombus from a myxoma, and the diagnosis was made postoperatively.
Cianciulli
Tomás F
TF
Department of Cardiology, Hospital of the Government of the City of Buenos Aires Dr. Cosme Argerich, C1155ADP, Buenos Aires, Argentina. tcianciulli@fibertel.com.ar
Saccheri
María C
MC
Redruello
Héctor J
HJ
Cosarinsky
Lucas A
LA
Celano
Leonardo
L
Trila
Carla S
CS
Parisi
Coloma E
CE
Prezioso
Horacio A
HA
D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D000925:Anticoagulants / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D016736:Antiphospholipid Syndrome / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003328:Coronary Thrombosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D006325:Heart Atria / Q000473:pathology*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D009232:Myxoma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D010477:Perfusion; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D012307:Risk Factors; D000069283:Rituximab; D014463:Ultrasonography; D014859:Warfarin / Q000627:therapeutic use
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000925:Anticoagulants; D000970:Antineoplastic Agents; D007155:Immunologic Factors; D000069283:Rituximab; D014859:Warfarin