Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts.
Division of Cardiology, Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts.
Tex Heart Inst J. 2022 Jul 1;49(4). doi: 10.14503/THIJ-20-7455.
Cardiac thrombus, the most common intracardiac mass, is typically seen in the left side of the heart in the presence of atrial fibrillation, mitral stenosis, or impaired global wall motion. Right atrial thrombus, which is rarer, is usually associated with central venous catheter placement or pulmonary embolism. We present the case of a 24-year-old woman with a history of mitral valve prolapse who presented with fatigue and palpitations. Echocardiograms and cardiac magnetic resonance images revealed a right atrial mass compatible with a myxoma. However, after surgical excision of this and a second mass discovered intraoperatively, pathologic evaluation confirmed organized thrombus rather than myxoma. The patient's only risk factor was her use of oral contraceptive pills. Test results for hypercoagulable disorders revealed the presence of antiphosphatidylserine, an uncommon antiphospholipid antibody. The patient stopped taking the contraceptive. This case suggests the need to examine further the role of antiphosphatidylserine antibodies in the diagnosis of antiphospholipid syndrome.
心脏血栓是最常见的心脏内肿块，通常见于存在心房颤动、二尖瓣狭窄或整体壁运动障碍的左心。较少见的右心房血栓通常与中心静脉导管放置或肺栓塞有关。我们报告了一例 24 岁女性病例，有二尖瓣脱垂病史，表现为疲劳和心悸。超声心动图和心脏磁共振图像显示右心房肿块符合黏液瘤。然而，在切除这个肿块和术中发现的第二个肿块后，病理评估证实为有组织的血栓，而不是黏液瘤。该患者唯一的危险因素是她使用口服避孕药。高凝状态检查结果显示存在抗磷脂酰丝氨酸，这是一种不常见的抗磷脂抗体。患者停止服用避孕药。该病例提示需要进一步研究抗磷脂酰丝氨酸抗体在抗磷脂综合征诊断中的作用。
