Kachalia Amit, Sideras Panagiotis, Javaid Mian, Muralidharan Sethu, Stevens-Cohen Pilar
J Assoc Physicians India. 2013 Nov;61(11):841-3.
Sixty six year old male with history of heart failure was admitted for dysphagia, weight loss. CT scan chest revealed diffuse oesophageal wall thickening. Upper endoscopy, oesophagogram confirmed diagnosis of achalasia. TTE revealed severely reduced biventricular systolic function with LVEF 10%; PASP 75-80 mmHg. Parasternal long views showed dilated coronary sinus with a visible, mobile 2.0 cm thrombus. Pro-thrombotic workup was negative. Coronary sinus thrombosis has been identified as a rare complication to invasive cardiac procedures causing damage to coronary sinus endothelium and in hypercoagulable states.Typically acute thrombosis presents with chest pain, dynamic ECG changes, but chronic development does not present with ischaemic signs due to formation of efficient collateral circulation. We present a case report of stable primary coronary sinus thrombus incidentally diagnosed, secondary to chronic venous stasis in coronary circulation. Currently, there are no guidelines to assist physicians in long term management of such patients and thus warrants further investigations.
一名66岁有心力衰竭病史的男性因吞咽困难、体重减轻入院。胸部CT扫描显示食管壁弥漫性增厚。上消化道内镜检查、食管造影确诊为贲门失弛缓症。经胸超声心动图显示双心室收缩功能严重降低，左心室射血分数为10%；肺动脉收缩压为75 - 80 mmHg。胸骨旁长轴切面显示冠状静脉窦扩张，可见一个2.0厘米的活动血栓。血栓前状态检查结果为阴性。冠状静脉窦血栓形成已被确认为侵入性心脏手术的一种罕见并发症，可导致冠状静脉窦内皮损伤以及处于高凝状态。典型的急性血栓形成表现为胸痛、动态心电图改变，但由于形成了有效的侧支循环，慢性发展时不会出现缺血体征。我们报告一例因冠状循环慢性静脉淤滞而偶然诊断出的稳定的原发性冠状静脉窦血栓病例。目前，尚无指南协助医生对这类患者进行长期管理，因此有必要进一步研究。
