title: Intracardiac thrombi in extracardiac disorders: an autopsy study.
abstract: BACKGROUND
  Intracardiac thrombi (ICT), more commonly encountered at autopsy, are well documented with underlying cardiovascular disease. Occurrence of ICT in systemic diseases without an intrinsic cardiac disorder is rare. The aim of this autopsy study was to highlight such an occurrence.
  
  
  METHODS
  From 1996 to 2010, cases with ICT unrelated to primary cardiac disorders were selected at autopsy and analyzed. Clinical and investigational data were obtained from the medical records. The location, morphology, size, and histological appearance of the thrombi were noted. The thrombi were then classified on the basis of their location, nature, and histology (fresh and/or organized); this was correlated with the clinical setting.
  
  
  RESULTS
  Among a total of 11,724 autopsies performed in 15 years, 276 patients (2.4%) had ICT. Of these, 45 patients (0.4%) had ICT that were unrelated to primary cardiac diseases. There were 25 men and 20 women with a mean age of 46.1 years. Antemortem diagnosis was not made in any of these patients. Eight patients each (35.6%) showed isolated left-sided and multichambered involvement, while the rest of the hearts (64.4%) had thrombi in the right-sided chamber(s). The recognizable risk factors were underlying cancers (24.4%), prolonged immobilization (20%), systemic lupus erythematosus (6.7%), pregnancy (4.4%), nephropathy (4.4%), primary antiphospholipid antibody syndrome (2.2%), and ulcerative colitis (2.2%). However, 16 patients (35.7%) had no obvious predisposing factor, although investigations for prothrombotic markers had not been done. Diabetes mellitus, chronic alcoholism, and deep vein thrombosis of the lower limbs had been clinically documented in some of them. The cause of death in most patients (73.3%) had been related to pulmonary and/or systemic thromboembolism.
  
  
  CONCLUSIONS
  This autopsy study emphasizes the great need for a higher index of suspicion of in situ thrombosis in the heart in hypercoagulable states so as to curtail the morbidity and mortality of the primary disease process.
authors.affiliation: Department of Pathology (Cardiovascular and Thoracic Division), Seth G. S. Medical College and K. E. M. Hospital, Mumbai, India. shreeprajai@yahoo.co.in
authors.forename: Pradeep
authors.initials: P
authors.lastname: Vaideeswar
authors.forename: Smita
authors.initials: S
authors.lastname: Divate
authors.forename: Megha
authors.initials: M
authors.lastname: Harke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D033162:Incidental Findings; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D012307:Risk Factors; D013927:Thrombosis / Q000175:diagnosis / Q000453:epidemiology*; D055815:Young Adult