[Right ventricular thrombi in primary antiphospholipid syndrome]

Area of Science:

• Cardiology
• Hematology
• Pathology

Background:

• Recurrent pulmonary emboli pose a diagnostic challenge, especially when peripheral venous thrombosis is absent.
• Right-ventricular masses require thorough investigation to differentiate neoplastic from thrombotic origins.

Observation:

• A 33-year-old male presented with recurrent pulmonary emboli and bilateral leg scans negative for thrombosis.
• Transesophageal echocardiography revealed two spherical masses within the right ventricle.
• Operative findings and subsequent histological examination confirmed the masses to be pure thrombi, not myxomas.

Findings:

• The patient exhibited lupus anticoagulant and elevated IgG cardiolipin antibodies, indicative of antiphospholipid syndrome.
• No local cardiac abnormalities predisposing to thrombus formation were identified.
• The primary antiphospholipid syndrome was diagnosed in the absence of an underlying etiological disease.

Implications:

• This case highlights the possibility of primary antiphospholipid syndrome presenting with unusual right-ventricular thrombi.
• Early diagnosis and anticoagulation are crucial for managing antiphospholipid syndrome and preventing thromboembolic events.
• Further research into the pathogenesis of intracardiac thrombi in antiphospholipid syndrome is warranted.