Biventricular thrombosis in a structurally normal heart at high altitude

Unexpected death due to a biventricular thrombosis: Case report and review of literature

Cardiac thrombosis is an unusual condition characterised by the formation of a clot in the heart chambers. Biventricular thrombosis with obstruction of blood flow and fatal cardiogenic shock is anecdotal. This report describes a rare biventricular thrombosis in an elderly woman without known risk factors which was diagnosed at autopsy. A complete autopsy is essential to ascertain the cause of death, especially in complex cases with little medical history. We suggest a possible explanation for the pathophysiological mechanism.

Massive Mobile Left Ventricular Thrombus in a Patient With Normal Left Ventricular Systolic Function

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Left ventricular thrombi (LVT) formation is associated with impaired LVEF.

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LVT are extremely rare among patients with normal ejection fraction.

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LVT may be clinically silent but may also present with embolization.

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Cardiac magnetic resonance is the gold standard noninvasive test to diagnose LVT.

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Large LVT are preferably treated with surgical excision.

Large Left Ventricular Thrombus in a Patient with Systemic and Venous Thromboembolism Secondary to Protein C and S Deficiency

58-year-old Hispanic female presented with an altered mental status. A CT scan of the head demonstrated multiple scattered infarcts and a large right temporal lobe infarct. We also diagnosed the patient with right popliteal and femoral vein thrombosis, bilateral pulmonary embolism, and a transient right radial artery occlusion. Her 12-lead EKG showed lateral ST elevation. Emergent coronary angiogram revealed normal coronaries. Echocardiogram demonstrated a large mobile mass attached to the anterolateral free wall with overall normal contractility of the left ventricle. The patient underwent surgical embolectomy to prevent further systemic embolization. Coagulability workup returned positive for protein C and S deficiency. The patient did well after surgery. Following her surgery, we initiated chronic oral anticoagulation. The presentation with intracardiac thrombus in a normal heart should raise a concern of a probable thrombophilia.