Right atrial thrombus mimicking myxoma with pulmonary embolism in a patient with systemic lupus erythematosus and secondary antiphospholipid syndrome

• Published in: Texas Heart Institute journal Vol. 35; no. 4; pp. 454 - 457
• Main Authors: Cianciulli, Tomás F, Saccheri, María C, Redruello, Héctor J, Cosarinsky, Lucas A, Celano, Leonardo, Trila, Carla S, Parisi, Coloma E, Prezioso, Horacio A
• Format: Journal Article
• Language: English
• Published: United States Texas Heart Institute 2008
• Subjects: Adult; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Murine-Derived; Anticoagulants - therapeutic use; Antineoplastic Agents - therapeutic use; Antiphospholipid Syndrome - complications; Antiphospholipid Syndrome - diagnosis; Antiphospholipid Syndrome - diagnostic imaging; Case Reports; Coronary Thrombosis - diagnosis; Coronary Thrombosis - diagnostic imaging; Coronary Thrombosis - physiopathology; Coronary Thrombosis - surgery; Diagnosis, Differential; Female; Heart Atria - pathology; Humans; Immunologic Factors - therapeutic use; Lupus Erythematosus, Systemic - complications; Lupus Erythematosus, Systemic - diagnosis; Lupus Erythematosus, Systemic - diagnostic imaging; Lupus Erythematosus, Systemic - physiopathology; Myxoma - diagnosis; Myxoma - diagnostic imaging; Myxoma - physiopathology; Myxoma - surgery; Perfusion; Pulmonary Embolism - diagnosis; Pulmonary Embolism - diagnostic imaging; Pulmonary Embolism - physiopathology; Pulmonary Embolism - surgery; Risk Factors; Rituximab; Ultrasonography; Warfarin - therapeutic use; recurrence; heart neoplasms/diagnosis; coronary thrombosis/complications/diagnosis/epidemiology/radiography/surgery; thrombosis/complications/diagnosis/etiology/pathology/prevention & control/surgery; antiphospholipid syndrome/complications; autoimmune diseases/complications; Antibodies, anticardiolipin/blood; heart atria; lupus erythematosus, systemic/complications; myxoma/diagnosis
• ISSN: 0730-2347; 1526-6702

Antiphospholipid syndrome is a well-defined entity that is characterized by spontaneous abortion, thrombocytopenia, and recurrent arterial and venous thromboses. A partially calcified right atrial thrombus mimicking myxoma with recurrent pulmonary embolism has not been previously reported in a patient who also had systemic lupus erythematosus and secondary antiphospholipid syndrome. Herein, we describe the case of a 37-year-old woman with systemic lupus erythematosus and secondary antiphospholipid syndrome who was admitted to the hospital with progressive exertional dyspnea. Ventilation-perfusion scanning showed multiple parenchymal defects in the lungs that portended pulmonary embolism. In addition, the scanning revealed normal regional ventilation. Transthoracic and transesophageal echocardiography showed a right atrial mass that was highly suggestive of myxoma, and the patient subsequently underwent surgery. A histologic examination showed an organized, partially calcified thrombus. Intracardiac thrombus has been rarely reported as a complication of antiphospholipid syndrome. In our patient, the preoperative investigations could not differentiate the partially calcified right atrial thrombus from a myxoma, and the diagnosis was made postoperatively.