Pylephlebitis presenting as spontaneous coronary sinus thrombosis: a case report

Area of Science:

• Cardiology
• Vascular Medicine
• Gastroenterology

Background:

• Coronary sinus thrombosis is a rare condition, often associated with infective endocarditis or medical procedures.
• This case presents an unusual instance of spontaneous coronary sinus thrombosis originating from an intra-abdominal infection.

Observation:

• A 61-year-old woman with end-stage renal disease and atrial fibrillation presented with abdominal pain.
• Incidental finding of a coronary sinus filling defect on CT scan, confirmed as thrombus via transesophageal echocardiogram.
• The thrombus was suspected to be embolic from a hepatic venous system infection secondary to recurrent diverticulitis and pylephlebitis.

Findings:

• The patient was initiated on warfarin for anticoagulation due to the coronary sinus thrombus and history of atrial fibrillation.
• Follow-up at 3 months showed complete resolution of the thrombus.

Implications:

• A high index of suspicion is crucial for diagnosing coronary sinus thrombosis in patients with intra-abdominal infections.
• Transesophageal echocardiography is valuable for diagnosis and monitoring treatment efficacy.
• This case underscores the importance of investigating the venous system in patients with abdominal infections to prevent delayed management of potential cardiac complications.