Acikel Sadik, Akdemir Ramazan, Dogan Mehmet, Kilic Harun, Yesilay Asuman Bicer
Department of Cardiology, Ministry of Health Dişkapi Yildirim Beyazit Research and Educational Hospital, Ankara, Turkey.
Echocardiography. 2010 Feb;27(2):198-201. doi: 10.1111/j.1540-8175.2009.01014.x. Epub 2010 Jan 22.
We report a 36-year-old woman with a 1-year history of systemic lupus erythematosus who was admitted with acute onset of dyspnea and chest pain. She presented with a classic medical history of antiphospholipid antibody syndrome, including spontaneous abortion, deep venous thrombosis, and clinical manifestations of lupus activation. The differential diagnosis was made after a detailed history and examinations with transthoracic/transesophageal echocardiography, deep venous ultrasonography, chest computed tomography, and coronary angiography. This case demonstrates a left ventricular apical thrombus in angiographically normal coronary arteries and also deep vein thrombosis causing acute pulmonary thromboembolism. Antiaggregant and anticoagulant therapies were initiated as a result of the presence of a left ventricular apical thrombus and deep venous thrombosis, which is predisposed to recurrent pulmonary or systemic embolization. Control echocardiography demonstrated resolution of apical thrombus and normalized left ventricular systolic function after aspirin, warfarin, and immunosuppressive therapy for 2 months.
我们报告一名36岁患有系统性红斑狼疮1年的女性，因急性呼吸困难和胸痛入院。她有抗磷脂抗体综合征的典型病史，包括自然流产、深静脉血栓形成以及狼疮活动的临床表现。在详细询问病史并进行经胸/经食管超声心动图、深静脉超声检查、胸部计算机断层扫描和冠状动脉造影检查后做出了鉴别诊断。该病例显示在冠状动脉造影正常的情况下左心室心尖部有血栓形成，同时存在深静脉血栓形成导致急性肺血栓栓塞。由于存在左心室心尖部血栓和深静脉血栓形成，易发生复发性肺栓塞或系统性栓塞，因此开始了抗血小板和抗凝治疗。在阿司匹林、华法林和免疫抑制治疗2个月后，对照超声心动图显示心尖部血栓溶解，左心室收缩功能恢复正常。
