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Large left ventricular thrombus surgically resected in a patient with normal ejection: A case report
Abdulkarim Abukhodair1, Mohammed S Alqarni1, Abdulmalek Alzahrani1
1College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
International Journal of Surgery Case Reports
|April 23, 2021
Summary
A rare left ventricular thrombus formed in a patient with normal ejection fraction, presenting with abdominal pain and splenic infarcts. Tofacitinib and progesterone use is suspected to have contributed to this hypercoagulable state.
Area of Science:
- Cardiology
- Vascular Medicine
- Pharmacology
Background:
- Left ventricular thrombus (LVT) is uncommon in patients with normal systolic function.
- This case highlights an unusual presentation of LVT in a patient with preserved ejection fraction.
Observation:
- A 57-year-old female presented with severe abdominal pain, nausea, vomiting, and constipation.
- Computed tomography (CT) revealed splenic infarcts; echocardiography identified a large, mobile left ventricular mass.
- Magnetic resonance imaging (MRI) indicated myocardial infarction in the left anterior descending artery territory, despite non-occluded coronary arteries.
Findings:
- The patient had a 20 mm × 40 mm mobile, hyperechogenic mass on the septo-apical wall of the left ventricle.
- Myocardial injury with non-occluded coronaries (MINOCA) and subsequent apical akinesia likely caused blood stasis.
- A hypercoagulable state, potentially induced by progesterone and tofacitinib, contributed to thrombus formation.
Implications:
- Urgent surgical intervention was necessary due to the high risk of embolization.
- Echocardiography is crucial for evaluating systemic embolism.
- Tofacitinib may be a potential risk factor for left ventricular clot formation.
