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Intracardiac thrombus discovered incidentally during respiratory distress in an 18-month-old infant: case report
Youssef Aarjouni1, Youssef Absa2, Charaf Sayouti2
1Department of Anesthesiology and Critical Care, Mohammed V Military Training Hospital, University Mohammed V of Rabat, Rabat, Morocco.
Insights
This case study details a rare giant intracardiac thrombus in an infant, linked to protein deficiencies. Medical management led to complete thrombus resolution, highlighting effective treatment for pediatric hypercoagulable states.
Area of Science:
- Pediatric Cardiology
- Hematology
- Critical Care Medicine
Background:
- Intracardiac thrombi (ICT) are rare in children and associated with high morbidity.
- Hypercoagulable states are an important consideration in pediatric ICT cases.
Observation:
- An 18-month-old infant presented with respiratory distress, cyanosis, and hypoxemia.
- Echocardiography revealed a large (32 mm x 22 mm) left ventricular mass, diagnosed as a thrombus.
- The thrombus was linked to deficiencies in proteins C and S.
Findings:
- Medical management including dobutamine, furosemide, and heparin was initiated.
- The patient showed favorable clinical progression with gradual oxygen weaning.
- Complete resolution of the intracardiac thrombus was achieved by day 15.
Implications:
- This case demonstrates the efficacy of medical management for pediatric ICT, potentially avoiding surgery.
- It emphasizes the need for early recognition of hypercoagulable states in pediatric patients with ICT.
- Further research is needed to define optimal treatment protocols for pediatric ICT, considering thrombus size and ventricular function.
Abstract:
Intracardiac thrombi (ICT) are uncommon in the pediatric population and can lead to significant morbidity and mortality. This case highlights a unique instance of a giant ICT in an 18-month-old infant with no notable medical history, contributing to the understanding of hypercoagulable states and their implications in pediatric patients. The patient presented with respiratory distress, characterized by a flu-like syndrome, cyanosis, and hypoxemia. Initial examination revealed lethargy and significant respiratory distress, with imaging showing lobar pneumonia and an echocardiogram revealing a 32 mm x22 mm heterogeneous mass in the left ventricle. Further investigations confirmed the mass was a thrombus, attributed to deficiencies in proteins C and S. The patient was treated with dobutamine to enhance contractility, furosemide for diuresis, and heparin for anticoagulation. There was a favorable progression, with gradual weaning from oxygen and complete resolution of the thrombus by day 15. This case underscores the importance of recognizing hypercoagulable states in pediatric patients with ICT. It suggests that medical management can be an effective alternative to surgical interventions. Moreover, it emphasizes the need for further research to establish optimal treatment protocols for pediatric ICT, particularly regarding the risks associated with thrombus size and ventricular function.
