Khachatryan Aleksan, Harutyunyan Hakob, Psotka Mitchell, Batikyan Ashot, Cinar Tufan, Khorsandi Michael, Alejandro Joel, Tamazyan Vahagn, Sargsyan Margarita
Department of Internal Medicine, University of Maryland Medical Center, Midtown Campus, Baltimore, USA.
Department of Internal Medicine, Maimonides Medical Center, New York, USA.
Cureus. 2024 Jun 4;16(6):e61674. doi: 10.7759/cureus.61674. eCollection 2024 Jun.
Left ventricular thrombus (LVT) has historically been reported as a complication of acute left ventricular (LV) myocardial infarction. It is most commonly observed in cases of LV systolic dysfunction attributed to ischemic or nonischemic etiologies. Conversely, the occurrence of LVT in normal LV systolic function is an exceptionally rare presentation and is predominantly associated with conditions such as hypereosinophilic syndrome (HES), cardiac amyloidosis, left ventricular noncompaction, hypertrophic cardiomyopathy (HCM), hypercoagulability states, immune-mediated disorders, and malignancies. Notably, hypereosinophilia (HE) has been linked with thrombotic events. Intracardiac thrombus is a well-known complication of eosinophilic myocarditis (EM) or Loeffler endomyocarditis, both of which are considered clinical manifestations of HES. We present a case of a 63-year-old male with normal LV systolic function, HE, and noncontributory hypercoagulability workup, who presented with thromboembolic complications arising from LVT. Interestingly, the diagnostic evaluation for EM and Loeffler endocarditis was nonconfirmatory. Additionally, we performed a literature review to delineate all similar cases. This article also outlines the pathophysiology, diagnosis, and treatment approaches for hypereosinophilic cardiac involvement with a specific focus on LVT.
左心室血栓（LVT）在历史上一直被报道为急性左心室（LV）心肌梗死的一种并发症。它最常见于由缺血性或非缺血性病因导致的左心室收缩功能障碍病例中。相反，左心室收缩功能正常时发生LVT是一种极为罕见的表现，主要与诸如嗜酸性粒细胞增多综合征（HES）、心脏淀粉样变性、左心室心肌致密化不全、肥厚型心肌病（HCM）、高凝状态、免疫介导性疾病和恶性肿瘤等疾病相关。值得注意的是，嗜酸性粒细胞增多（HE）与血栓形成事件有关。心内血栓是嗜酸性粒细胞性心肌炎（EM）或吕弗勒心内膜炎的一种众所周知的并发症，这两种疾病都被认为是HES的临床表现。我们报告一例63岁男性患者，其左心室收缩功能正常，存在HE，且高凝状态检查无异常，该患者因LVT出现了血栓栓塞并发症。有趣的是，对EM和吕弗勒心内膜炎的诊断评估未得到证实。此外，我们进行了文献综述以描述所有类似病例。本文还概述了嗜酸性粒细胞增多累及心脏的病理生理学、诊断和治疗方法，特别关注LVT。
