Bräuninger S, Winckelmann G, Bohle R M, Bauer E, Stellwaag M, Lambertz H
Fachbereich Kardiologie, Deutsche Klinik für Diagnostik, Wiesbaden.
Dtsch Med Wochenschr. 1995 May 12;120(19):676-80. doi: 10.1055/s-2008-1055395.
Over a period of several months a 33-year-old man had recurrent pulmonary emboli. No thromboses could be demonstrated in the peripheral venous system. Transoesophageal echocardiography showed two spherical space-occupying structures in the right ventricle which were removed operatively under the suspected diagnosis of multilobular myxomas. However, their histological examination revealed pure thrombi that had grown by apposition. This unusual findings of right-ventricular thrombi could not be explained pre- and intraoperatively by any local thrombi-favouring changes in the right heart. Tests of clotting mechanisms demonstrated lupus anticoagulant (kaolin-clotting-time mixture test: LA index 21.7 [normal: < 15]), as well as an increased IgG cardiolipin antibody concentration of 19.3 U/l). As no underlying disease was discovered, the diagnosis was by definition primary antiphospholipid syndrome. No further thrombo-embolism has occurred during continuing oral anticoagulation with phenprocoumon.
在几个月的时间里，一名33岁男子反复发生肺栓塞。外周静脉系统未发现血栓形成。经食管超声心动图显示右心室内有两个球形占位性结构，在疑似多叶黏液瘤的诊断下进行了手术切除。然而，组织学检查显示为单纯的附壁生长血栓。右心室血栓这一不寻常的发现，在术前和术中均无法用右心内任何有利于血栓形成的局部变化来解释。凝血机制检测显示存在狼疮抗凝物（高岭土凝血时间混合试验：狼疮抗凝物指数21.7[正常：<15]），以及IgG心磷脂抗体浓度升高至19.3 U/l）。由于未发现潜在疾病，根据定义诊断为原发性抗磷脂综合征。在继续使用苯丙香豆素进行口服抗凝治疗期间，未再发生血栓栓塞事件。
