Chiu Yu-Cheng, Chen Jiann-Hwa, Chen Wei-Lung, Chung Jui-Yuan
Department of Emergency Medicine, Cathay General Hospital, Taipei, Taiwan.
School of Medicine, Fu Jen Catholic University, Taipei, Taiwan.
J Med Ultrasound. 2024 Jun 26;33(3):269-271. doi: 10.4103/jmu.jmu_151_23. eCollection 2025 Jul-Sep.
The left atrium (LA) thrombus is a life-threatening disease that can result in systemic embolization and sudden death if misdiagnosed. Point-of-care ultrasound (POCUS) is an efficient tool able to assist emergency physicians in accurately and promptly identifying patients with LA thrombus. We present a 72-year-old man who presented at the emergency department with out-of-hospital cardiac arrest. The patient received cardiopulmonary resuscitation and achieved spontaneous circulation upon arrival. The patient had a past history of mitral valve regurgitation and valve replacement, followed by warfarin treatment for 5 years. Clinical examination, including POCUS, resulted in a diagnosis of LA thrombus with systemic thromboembolism events affecting the brain, kidney, and lower limbs. Although an emergency thrombectomy was performed immediately, the patient eventually died. POCUS should be performed in patients with any prior history of structural heart disease, especially those who received valve replacement surgery, to identify life-threatening thromboembolism events and facilitate prompt treatment.
左心房(LA)血栓是一种危及生命的疾病,如果误诊,可能导致全身栓塞和猝死。床旁超声(POCUS)是一种有效的工具,能够帮助急诊医生准确、及时地识别患有左心房血栓的患者。我们报告一名72岁男性,他在急诊科因院外心脏骤停就诊。患者接受了心肺复苏,到达时恢复了自主循环。该患者既往有二尖瓣反流和瓣膜置换病史,随后接受了5年的华法林治疗。包括POCUS在内的临床检查诊断为左心房血栓,并伴有影响脑、肾和下肢的全身血栓栓塞事件。尽管立即进行了紧急血栓切除术,但患者最终死亡。对于有任何结构性心脏病既往史的患者,尤其是接受过瓣膜置换手术的患者,应进行床旁超声检查,以识别危及生命的血栓栓塞事件并促进及时治疗。