[Antiphospholipid syndrome with massive right atrial thrombus. Differential diagnosis of myxoma]

Antiphospholipidsyndrome is a well-defined entity characterized by spontaneous abortion, thrombocytopenia and recurrent arterial and venous thromboses. The diagnosis is biochemically verified by the presence of antibodies binding to negatively charged phospholipids. A patient with recurrent thromboembolic complications over the years eventually developed a rapidly progressing dyspnoe. Two-dimensional echocardiography showed a large right atrial mass which at operation proved to be a thrombus. Coombs test was positive as were lupus anticoagulans and antibodies against cardiolipin, in addition to thrombocytopenia and prolonged bleeding time. The author reviews the literature and discusses problems regarding diagnostical criteria for antiphospholipidsyndrome, pathogenesis of the "procoagulopathy" and thrombembolic complications associated with the syndrome. Special consideration is given to non-invasive diagnostic methods for distinguishing between atrial myxom and floating thrombus.