Ballo Piercarlo, Fibbi Veronica, Granelli Massimo, Fusco Francesca, Abbondanti Alessandro, Fantini Andrea, Bartalini Mattia, Consalvo Matteo, Fazi Antonio, Santoro Giovanni M
Cardiology Unit, S. Maria Annunziata Hospital, Florence, Italy.
Emergency Department, S. Maria Annunziata Hospital, Florence, Italy.
Oxf Med Case Reports. 2018 Jun 11;2018(6):omy019. doi: 10.1093/omcr/omy019. eCollection 2018 Jun.
Right-sided intracardiac thrombi are potential causes of right ventricular (RV) failure, particularly when tricuspid or pulmonary obstruction occurs. In most cases, RV thrombus develops in patients with RV dysfunction and concomitant thrombosis in the systemic veins. However, RV thrombosis can rarely present as an isolated mass and despite preserved RV function, particularly in patients with thrombophilic states. In this report, we describe an unusual case of giant isolated RV thrombus presenting with acute RV failure secondary to dynamic RV outflow tract obstruction in a patient with renal carcinoma. Bedside echocardiography allowed a rapid assessment of the hemodynamic effects of the mass. The possibility of a thrombotic RV outflow obstruction should be considered in patients with acute RV failure, even in those with no evidence of thrombosis in the venous district. This may be particularly important in patients with prothrombotic states, where the effectiveness of routine thromboembolic prophylaxis could be reduced.
右侧心腔内血栓是导致右心室（RV）衰竭的潜在原因，尤其是在发生三尖瓣或肺动脉梗阻时。在大多数情况下，RV血栓形成于RV功能不全且伴有体静脉血栓形成的患者。然而，RV血栓很少以孤立肿块的形式出现，且尽管RV功能正常，在存在血栓形成倾向的患者中尤其如此。在本报告中，我们描述了一例罕见的巨大孤立性RV血栓病例，该患者为肾癌患者，因动态RV流出道梗阻继发急性RV衰竭。床旁超声心动图能够快速评估该肿块的血流动力学影响。即使在静脉区域没有血栓形成证据的急性RV衰竭患者中，也应考虑RV流出道血栓性梗阻的可能性。这在血栓形成倾向患者中可能尤为重要，因为常规血栓栓塞预防措施的有效性可能会降低。
