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Intracardiac mural thrombus mimicking atrial myxoma in the antiphospholipid syndrome
1Section of Rheumatology, St. Paul-Ramsey Medical Center, MN 55101.
Insights
Antiphospholipid syndrome (APS) can cause cardiac issues. Researchers found intracardiac mural thrombus, often mistaken for atrial myxomata, may be an APS manifestation.
Area of Science:
- Cardiology
- Rheumatology
- Pathology
Background:
- Antiphospholipid antibodies (aPL) are associated with various cardiac conditions, including valvular lesions and myocardial dysfunction.
- These cardiac manifestations suggest a potential role within the antiphospholipid syndrome (APS).
Observation:
- Three patients with APS (primary or with SLE) presented with right atrial masses identified via echocardiography and angiography.
- Preoperative assessments suggested atrial myxomata.
Findings:
- Pathological examination of resected masses revealed organized, calcified thrombus, not myxomata.
- Follow-up ranged from 12 months to 7 years, with one case showing possible thrombus recurrence after 7 years.
Implications:
- Intracardiac mural thrombus is proposed as an additional cardiac manifestation of APS.
- Distinguishing these thrombi from atrial myxomata poses diagnostic challenges.
Abstract:
A wide spectrum of cardiac involvement including valvular lesions, myocardial infarction and myocardial dysfunction has been reported in patients with antiphospholipid antibodies (aPL), suggesting that cardiac manifestations may be part of the antiphospholipid syndrome (APS). We describe 3 patients (2 with primary APS and one with APS and SLE) who were found to have right atrial masses by echocardiography (transthoracic and/or transesophageal) and/or angiography, which were felt preoperatively to be atrial myxomata. Pathological examination of resected material showed only organized thrombus with calcification. We describe outcome 12 months to 7 years after resection of thrombus and document possible recurrence in one patient after 7 years. Intracardiac mural thrombus may be an additional cardiac manifestation of the APS, and presents considerable diagnostic confusion in its differentiation from atrial myxomata.