Aarjouni Youssef, Absa Youssef, Sayouti Charaf, Dafali Larbi, Bentalha Aziza, Kettani Salma Echcherif
Department of Anesthesiology and Critical Care, Mohammed V Military Training Hospital, University Mohammed V of Rabat, Rabat, Morocco.
Department of Anesthesiology and Critical Care, The Children's Hospital of Rabat, University Mohammed V of Rabat, Morocco.
Pan Afr Med J. 2025 Jan 13;50:24. doi: 10.11604/pamj.2025.50.24.45613. eCollection 2025.
Intracardiac thrombi (ICT) are uncommon in the pediatric population and can lead to significant morbidity and mortality. This case highlights a unique instance of a giant ICT in an 18-month-old infant with no notable medical history, contributing to the understanding of hypercoagulable states and their implications in pediatric patients. The patient presented with respiratory distress, characterized by a flu-like syndrome, cyanosis, and hypoxemia. Initial examination revealed lethargy and significant respiratory distress, with imaging showing lobar pneumonia and an echocardiogram revealing a 32 mm x22 mm heterogeneous mass in the left ventricle. Further investigations confirmed the mass was a thrombus, attributed to deficiencies in proteins C and S. The patient was treated with dobutamine to enhance contractility, furosemide for diuresis, and heparin for anticoagulation. There was a favorable progression, with gradual weaning from oxygen and complete resolution of the thrombus by day 15. This case underscores the importance of recognizing hypercoagulable states in pediatric patients with ICT. It suggests that medical management can be an effective alternative to surgical interventions. Moreover, it emphasizes the need for further research to establish optimal treatment protocols for pediatric ICT, particularly regarding the risks associated with thrombus size and ventricular function.
心内血栓（ICT）在儿科人群中并不常见，可导致严重的发病和死亡。本病例突出了一名18个月大、无明显病史的婴儿出现巨大ICT的独特情况，有助于理解高凝状态及其在儿科患者中的影响。该患者表现为呼吸窘迫，特征为类似流感的综合征、发绀和低氧血症。初步检查发现嗜睡和严重呼吸窘迫，影像学显示大叶性肺炎，超声心动图显示左心室有一个32毫米×22毫米的不均匀肿块。进一步检查证实该肿块为血栓，归因于蛋白C和S缺乏。患者接受多巴酚丁胺治疗以增强收缩力，呋塞米进行利尿，肝素进行抗凝。病情进展良好，到第15天时逐渐停用氧气，血栓完全溶解。本病例强调了识别患有ICT的儿科患者高凝状态的重要性。这表明药物治疗可以是手术干预的有效替代方法。此外，它强调需要进一步研究以建立儿科ICT的最佳治疗方案，特别是关于与血栓大小和心室功能相关的风险。
