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Right Ventricular Thrombus in a 36-Year-Old Man with Factor V Leiden.

Hajsadeghi S, Naghshin R, Hejrati M, Kerman SR - J Tehran Heart Cent (2015)

Bottom Line: Paraclinical studies demonstrated a right ventricular thrombus.Additional investigation was done to find the underlying cause.It seems that medical noninvasive treatments can be an alternative therapy to surgery when a ventricular thrombus is suspected in these patients.

View Article: PubMed Central - PubMed

Affiliation: Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.

ABSTRACT
Factor V Leiden deficiency is the most common hereditary hypercoagulable disease in the United States and involves 5% of the Caucasian population. Up to 30% of patients who present with deep vein thrombosis (DVT) or pulmonary thromboembolism present with this condition. This is a case report of a 36-year-old man who experienced one episode of DVT within the previous year and was admitted to our hospital due to productive coughs and hemoptysis. Paraclinical studies demonstrated a right ventricular thrombus. Additional investigation was done to find the underlying cause. Laboratory tests were positive for Factor V Leiden mutation. Other factors for hypercoagulability states were normal. Given that Factor V Leiden mutation is a life-threatening condition with a relatively high prevalence and considering its thrombogenesis, screening tests are necessary in young patients without obvious reasons for recurrent thrombus formation. It seems that medical noninvasive treatments can be an alternative therapy to surgery when a ventricular thrombus is suspected in these patients.

No MeSH data available.


Related in: MedlinePlus

Chest X-ray, showing a normal pattern
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Figure 1: Chest X-ray, showing a normal pattern

Mentions: A 36-year-old male non-smoker was admitted to our clinic with intermittent productive coughs and hemoptysis in the previous 2 months for further evaluation. He mentioned that the coughs had started 7 months previously and that they were relieved with Salbutamol spray, leaving him symptom-free for 2 months. The patient had never complained of chest pain or paroxysmal nocturnal dyspnea and orthopnea before. However, his condition began to deteriorate after 2 months since the previous medication was not effective enough, and he referred to a pulmonologist. In his medical history, DVT in the left leg was noticeable in about 1.5 years previously, which at the time led to his hospital admission for anticoagulant therapy. One week afterward, he was discharged on daily Warfarin and was arranged to have international normalized ratio (INR) follow-up. Unfortunately, due to thyroid hemorrhage, he underwent a partial thyroidectomy and Levothyroxine was added to his medical treatment and the Warfarin dose was decreased. He was under treatment with low-dose Warfarin when he referred to our clinic. In social history, he only stated occasional alcohol intake. There was no history of malignancy, emboli, antiphospholipid antibody syndrome, and other types of hypercoagulable states in his family. In physical examination, no lymphadenopathy was detected and everything else was unremarkable. Primary laboratory data revealed normocytic anemia (hemoglobin = 10.9), with normal serum iron level and total iron-binding capacity. Other routine laboratory tests were within normal ranges. The pulmonary function test demonstrated small airway obstruction with a 19.2% rise in the forced expiratory volume in one second (FEV1) after short-acting beta-agonist inhalation. Electrocardiography (ECG) showed normal sinus rhythm with a normal axis, and there were no ST-T segment changes. Chest X-ray illustrated a normal pattern (Figure 1). Echocardiography revealed normal left ventricular size with good systolic function (ejection fraction = 55%), normal right ventricular size and function, no wall motion abnormality, and mild tricuspid regurgitation. The pulmonary artery pressure was estimated at 35 mmHg. A large (36 × 20 mm), echogenic semi-mobile mass was seen in the right ventricle attached to the interventricular septum (Figure 2). Thoracic spiral multi-slice double-contrast computed tomography (CT) demonstrated a filling defect in the right ventricle, measuring 35 mm (Figure 3). No pulmonary artery embolism was detected in CT angiography. Cardiac magnetic resonance imaging (CMR) demonstrated a lobulated mass lesion in the right ventricle (38 × 26 mm), with invasion into the interventricular septum, suggestive of thrombosis according to different sequences. Abnormal enhancement in the right lung, most probably due to pulmonary infarction, was further depicted. The other parameters ware normal (Figure 4). Venous Doppler ultrasound of the lower extremities showed no evidence of DVT. For the evaluation of anemia, upper and lower gastrointestinal endoscopy was done, which detected no pathology. Bone marrow aspiration was normal. Paroxysmal nocturnal hematuria (characterized by the triad of hemolytic anemia, hematuria, and thrombosis) was ruled out by the Ham test. The patient was tested for coagulation factor activity, and the screening test was positive for Factor V Leiden. We decided to treat the patient with medical therapy. Anticoagulant therapy was administrated forthwith (Heparin drip and Warfarin). He was discharged with advice for Warfarin consumption and follow-up. After a 2-month follow-up, there was no sign of any mass in echocardiography (Figure 5).


Right Ventricular Thrombus in a 36-Year-Old Man with Factor V Leiden.

Hajsadeghi S, Naghshin R, Hejrati M, Kerman SR - J Tehran Heart Cent (2015)

Chest X-ray, showing a normal pattern
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4494519&req=5

Figure 1: Chest X-ray, showing a normal pattern
Mentions: A 36-year-old male non-smoker was admitted to our clinic with intermittent productive coughs and hemoptysis in the previous 2 months for further evaluation. He mentioned that the coughs had started 7 months previously and that they were relieved with Salbutamol spray, leaving him symptom-free for 2 months. The patient had never complained of chest pain or paroxysmal nocturnal dyspnea and orthopnea before. However, his condition began to deteriorate after 2 months since the previous medication was not effective enough, and he referred to a pulmonologist. In his medical history, DVT in the left leg was noticeable in about 1.5 years previously, which at the time led to his hospital admission for anticoagulant therapy. One week afterward, he was discharged on daily Warfarin and was arranged to have international normalized ratio (INR) follow-up. Unfortunately, due to thyroid hemorrhage, he underwent a partial thyroidectomy and Levothyroxine was added to his medical treatment and the Warfarin dose was decreased. He was under treatment with low-dose Warfarin when he referred to our clinic. In social history, he only stated occasional alcohol intake. There was no history of malignancy, emboli, antiphospholipid antibody syndrome, and other types of hypercoagulable states in his family. In physical examination, no lymphadenopathy was detected and everything else was unremarkable. Primary laboratory data revealed normocytic anemia (hemoglobin = 10.9), with normal serum iron level and total iron-binding capacity. Other routine laboratory tests were within normal ranges. The pulmonary function test demonstrated small airway obstruction with a 19.2% rise in the forced expiratory volume in one second (FEV1) after short-acting beta-agonist inhalation. Electrocardiography (ECG) showed normal sinus rhythm with a normal axis, and there were no ST-T segment changes. Chest X-ray illustrated a normal pattern (Figure 1). Echocardiography revealed normal left ventricular size with good systolic function (ejection fraction = 55%), normal right ventricular size and function, no wall motion abnormality, and mild tricuspid regurgitation. The pulmonary artery pressure was estimated at 35 mmHg. A large (36 × 20 mm), echogenic semi-mobile mass was seen in the right ventricle attached to the interventricular septum (Figure 2). Thoracic spiral multi-slice double-contrast computed tomography (CT) demonstrated a filling defect in the right ventricle, measuring 35 mm (Figure 3). No pulmonary artery embolism was detected in CT angiography. Cardiac magnetic resonance imaging (CMR) demonstrated a lobulated mass lesion in the right ventricle (38 × 26 mm), with invasion into the interventricular septum, suggestive of thrombosis according to different sequences. Abnormal enhancement in the right lung, most probably due to pulmonary infarction, was further depicted. The other parameters ware normal (Figure 4). Venous Doppler ultrasound of the lower extremities showed no evidence of DVT. For the evaluation of anemia, upper and lower gastrointestinal endoscopy was done, which detected no pathology. Bone marrow aspiration was normal. Paroxysmal nocturnal hematuria (characterized by the triad of hemolytic anemia, hematuria, and thrombosis) was ruled out by the Ham test. The patient was tested for coagulation factor activity, and the screening test was positive for Factor V Leiden. We decided to treat the patient with medical therapy. Anticoagulant therapy was administrated forthwith (Heparin drip and Warfarin). He was discharged with advice for Warfarin consumption and follow-up. After a 2-month follow-up, there was no sign of any mass in echocardiography (Figure 5).

Bottom Line: Paraclinical studies demonstrated a right ventricular thrombus.Additional investigation was done to find the underlying cause.It seems that medical noninvasive treatments can be an alternative therapy to surgery when a ventricular thrombus is suspected in these patients.

View Article: PubMed Central - PubMed

Affiliation: Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.

ABSTRACT
Factor V Leiden deficiency is the most common hereditary hypercoagulable disease in the United States and involves 5% of the Caucasian population. Up to 30% of patients who present with deep vein thrombosis (DVT) or pulmonary thromboembolism present with this condition. This is a case report of a 36-year-old man who experienced one episode of DVT within the previous year and was admitted to our hospital due to productive coughs and hemoptysis. Paraclinical studies demonstrated a right ventricular thrombus. Additional investigation was done to find the underlying cause. Laboratory tests were positive for Factor V Leiden mutation. Other factors for hypercoagulability states were normal. Given that Factor V Leiden mutation is a life-threatening condition with a relatively high prevalence and considering its thrombogenesis, screening tests are necessary in young patients without obvious reasons for recurrent thrombus formation. It seems that medical noninvasive treatments can be an alternative therapy to surgery when a ventricular thrombus is suspected in these patients.

No MeSH data available.


Related in: MedlinePlus