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Massive left atrial thrombus: a possible paraneoplastic complication of breast carcinoma
D Wrisley1, A Giambartolomei, I Lee
1SUNY Health Science Center.
Insights
This case study highlights a rare instance where breast cancer recurrence coincided with the development of a massive left atrial thrombus, suggesting a potential link between cancer dissemination and thrombosis in patients with rheumatic heart disease.
Area of Science:
- Cardiology
- Oncology
- Pathology
Background:
- Rheumatic mitral valve disease can lead to left atrial enlargement and increase the risk of thrombus formation.
- Antithrombotic therapy, such as aspirin, is often used post-operatively for patients with atrial thrombus.
- The interplay between malignancy and thrombotic events requires further investigation.
Observation:
- A patient with a history of rheumatic mitral valve disease and left atrial thrombus developed breast cancer.
- Following cancer surgery, a significant left atrial mass reappeared and was identified as a thrombus.
- The reappearance of the atrial thrombus showed a temporal correlation with cancer recurrence and dissemination.
Findings:
- The massive left atrial thrombus developed concurrently with metastatic breast cancer.
- This suggests a potential prothrombotic state induced by the disseminated carcinoma.
- The patient's history of rheumatic heart disease may have predisposed her to thrombus formation.
Implications:
- This case underscores the complex relationship between cancer and thrombosis, particularly in patients with underlying cardiac conditions.
- Further research is needed to elucidate the mechanisms linking cancer dissemination to atrial thrombus formation.
- Clinicians should maintain a high index of suspicion for thrombotic events in cancer patients, especially those with pre-existing cardiac conditions.
Abstract:
We describe a patient with long-standing rheumatic mitral valve disease, left atrial dilatation, and a precommissurotomy history of left atrial thrombus. Following operation she was maintained on daily aspirin as an antithrombotic measure. For 6 years she had no evidence, echocardiographically, of left atrial thrombus. She underwent surgery for apparently nonmetastatic breast cancer in early 1986. In May 1986 the left atrium was echocardiographically clear. At approximately the same time, recurrence was found at the suture line. In October 1987, two metastatic lung lesions and a very large left atrial mass were detected by computed tomography. The atrial mass was surgically removed and found to be a thrombus. There was a striking temporal correlation between dissemination of carcinoma and development of a massive atrial thrombus.