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Extensive intracardiac thrombi in a patient with heart failure and hepatic congestion: a case report
Bernard Wong1, Timothy Glenie1, Eileen Merriman2
1Department of Cardiology, North Shore Hospital, 124 Shakespeare Road, Takapuna, Auckland, New Zealand.
Insights
Intracardiac masses, potentially thrombi, resolved with warfarin therapy in a patient with liver disease. Cardiac MRI confirmed the diagnosis and treatment effectiveness, highlighting liver disease as a prothrombotic risk factor.
Area of Science:
- Cardiology
- Radiology
- Hematology
Background:
- Left ventricular (LV) thrombi are complications of myocardial infarction, cardiomyopathies, and LV aneurysms.
- Right-sided intracardiac thrombi can stem from various prothrombotic conditions.
- Liver disease can present prothrombotic risks not always detected by standard coagulation tests.
Background:
Left ventricular (LV) thrombi is a complication associated with anterior ST-elevation myocardial infarction, dilated cardiomyopathies, or LV aneurysms. Right sided intracardiac thrombi may be associated with other prothrombotic causes.
Case Summary:
A 66-year-old man admitted with congestive heart failure was found to have extensive intracardiac masses on transthoracic echocardiography and cardiac magnetic resonance imaging (MRI). This occurred in the absence of a recent myocardial infarction. During his hospital stay, he was found to have deranged liver enzymes and coagulation profile due to hepatic congestion. The patient was presumed to have intracardiac thrombi and was treated with warfarin therapy. There was complete resolution of the masses on repeat cardiac MRI after 4 weeks of treatment, confirming the diagnosis.
Discussion:
Cardiac MRI is useful in the diagnosis of intracardiac thrombi. Clinicians should appreciate the prothrombotic risks associated with liver disease, despite the inability of standard coagulation tests to quantify this risk.
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