Left ventricular thrombus mimicking primary cardiac tumor in a patient with primary antiphospholipid syndrome and recurrent systemic embolism.
Primary antiphospholipid syndrome (APS) is a well-defined entity characterized by spontaneous and recurrent abortion, thrombocytopenia and recurrent vascular thromboses (arterial and venous). Left ventricular thrombus mimicking primary cardiac tumor with recurrent systemic embolism has not been previously reported. In this report we describe a 39 year-old man admitted to hospital presenting with left hemiparesis and a peripheral embolism. He had no history of thrombotic events. Transthoracic echocardiography showed a large, polypoid and mobile mass (4.0 x 1.2 cm) attached to the apex of the left ventricle, highly suggestive of primary cardiac tumor. The patient subsequently underwent open heart surgery. The histological examination showed an older thrombus and a fresh thrombus. Post-operative laboratory tests showed lupus anticoagulant activity, confirming the primary APS diagnosis. The patient initiated treatment with oral anticoagulation (INR levels between 2 and 3) and was discharged 29 days after surgery. At ten month follow-up, he was symptom-free with long-term anticoagulation therapy. No evidence of intracardiac mass recurrence on two-dimensional echocardiography was seen. Intracardiac thrombus has been rarely reported as a complication of primary APS. Left ventricular mass mimicking primary cardiac tumor with recurrent systemic embolism has not been previously reported. Pre-operative investigations could not distinguish such a thrombus from a cardiac tumor and the diagnosis was made post-operatively.
Cianciulli
Tomás F
TF
Departments of Cardiology, Hospital of the Government of the City of Buenos Aires Dr. Cosme Argerich, Buenos Aires, Argentina. tcianciulli@fibertel.com.ar
Saccheri
María C
MC
Lax
Jorge A
JA
Neme
Roberto O
RO
Sevillano
Juan F Alvarez
JF
Maiori
María E
ME
Lound
Sebastian Fandino
SF
Parisi
Coloma E
CE
Prezioso
Horacio A
HA
Vidal
Luis A
LA
D000284:Administration, Oral; D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage; D016736:Antiphospholipid Syndrome / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D006348:Cardiac Surgical Procedures; D003937:Diagnosis, Differential; D004617:Embolism / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D006338:Heart Neoplasms / Q000175:diagnosis*; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D012008:Recurrence; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D016896:Treatment Outcome; D014463:Ultrasonography
D000925:Anticoagulants