Acute myocarditis with thrombus near left ventricular outflow tract
Nicholas J Whitehead1, Stuart Murch1, James W Leitch1
1Department of Cardiovascular Medicine, John Hunter Hospital, Newcastle, NSW, Australia.
Echocardiography (Mount Kisco, N.Y.)
|February 20, 2018
Summary
A rare case of fulminant heart failure in a young woman was linked to a left ventricular outflow tract thrombus. Prompt treatment with anticoagulation and steroids resolved the mass and improved heart function.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Pathology
Background:
- Fulminant heart failure presents a diagnostic challenge, especially when cardiac masses are identified.
- The left ventricular outflow tract (LVOT) is a critical area for cardiac function and blood flow.
Observation:
- A young woman presented with acute, severe heart failure and a mass near the LVOT.
- Initial echocardiography showed severe left ventricular dysfunction and an LVOT mass of unclear etiology.
Findings:
- Advanced imaging (transesophageal echocardiography, cardiac MRI) suggested a thrombus at the basal anterior wall, near the LVOT.
- Cardiac biopsy revealed giant cell myocarditis as the likely underlying cause.
- The patient's condition improved with anticoagulation, steroids, and heart failure management, leading to thrombus resolution.
Implications:
- This case highlights the importance of considering cardiac thrombus in young patients with unexplained heart failure.
- Giant cell myocarditis can manifest with LVOT thrombus, necessitating a multimodal diagnostic approach.
- Successful management involves addressing both the thrombus and the underlying inflammatory process.
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