Department of Anesthesiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China.
BMC Anesthesiol. 2024 Sep 5;24(1):309. doi: 10.1186/s12871-024-02698-0.
Ball thrombus is rare and life-threatening. The correct diagnosis and timely management are key to improving patient prognosis. Here, we present a case report and literature review of ball thrombus.
A 75-year-old woman presented to our outpatient clinic because of palpitations and chest distress for 8 months. She was diagnosed mitral stenosis, and transthoracic echocardiography (TTE) showed a round mass attached to the left atrial (LA) wall. Before anesthesia induction, TTE found that the mass has dropped from the LA wall, and was spinning in the LA causing intermittent obstruction of the valve. Anesthesia induction was then carried out under TTE monitoring, and transesophageal echocardiograph found another mass in the LA appendage after intubation. She underwent LA mass removal and mitral valve replacement, and was discharged uneventfully. Histopathology confirmed the diagnosis of thrombus. Our literature review identified 19 cases of ball thrombus between 2015 and 2024. The average age was 54.8 (range 3-88) years. Heart failure was present as the initial symptom in 11 cases, and most patients had mitral valve disease or concomitant with atrial fibrillation. 12 cases received surgery, and 7 received medical treatment only. 2 deaths occurred, one due to the obstruction of left ventricular inflow tract and the other due to the worsening of heart failure.
Ball thrombus is rare in clinical settings. Urgent thrombectomy should be performed as soon as possible, and echocardiography can be used for real-time monitoring during surgery.
球型血栓较为罕见且危及生命。正确的诊断和及时的处理是改善患者预后的关键。在此，我们报告 1 例球型血栓病例并进行文献复习。
一名 75 岁女性因心悸和胸痛 8 个月来我院门诊就诊。她被诊断为二尖瓣狭窄，经胸超声心动图（TTE）显示左心房（LA）壁上附着一个圆形肿块。在麻醉诱导前，TTE 发现肿块已从 LA 壁脱落，并在 LA 内旋转，导致瓣膜间歇性阻塞。随后在 TTE 监测下进行麻醉诱导，气管插管后经食管超声心动图发现 LA 附件内还有另一个肿块。患者接受 LA 肿块切除术和二尖瓣置换术，术后顺利出院。组织病理学证实诊断为血栓。我们的文献复习确定了 2015 年至 2024 年间的 19 例球型血栓病例。平均年龄为 54.8（范围 3-88）岁。11 例患者以心力衰竭为首发症状，大多数患者存在二尖瓣疾病或合并心房颤动。12 例患者接受了手术治疗，7 例仅接受了药物治疗。有 2 例死亡，1 例是由于左心室流入道阻塞，另 1 例是由于心力衰竭恶化。
球型血栓在临床较为罕见。应尽快进行紧急血栓切除术，并且可以在手术过程中使用超声心动图进行实时监测。
