European Journal of Echocardiography; December 2014, Vol. 15 Issue: Supplement 2 pii4-ii4, 1p
Abstrakt:
61 years-old caucasian man, with medical history of T-cell lymphoma diagnosed 3 years ago. He was treated with chemotherapy and immunotherapy, with no treatment for 16 months. He was admitted to the hospital because of sepsis with respiratory source. Transthoracic Echocardiogram (TTE) revealed normal left ventricular (LV) dimensions and preserved systolic function, without changes in segmental contractility. In LV, was observed a bulky and movable mass, occupying the apex and majority of cavity, with 63.7x39mm, heterogeneous, with no ventricular wall invasion. TTE did not show others significant alterations. Patient (ptt) underwent cardiac magnetic resonance (CMR) which confirmed the mass and suggested cardiac involvement by lymphoma. During this exam, the ptt became in respiratory arrest and focal neurologic signs appeared. After advanced life support, the TTE revealed that almost all mass disappeared. There was regression of neurologic signals, however ptt developed ischemic colitis and inferior limbs ischemia with severe rhabdomyolysis (creatine kinase 21516U/L). Computerized tomography revealed no encephalic lesions, however documented splenic, intestinal and aortic embolization. The diagnostic hypothesis was a cardiac involvement of a lymphoproliferative disorder or a thrombus with systemic embolization. The ptt underwent thromboembolectomy of the aortic bifurcation. The histological examination of the surgical piece identified an organized thrombus without evidence of neoplastic cells. The ptt was started on oral anticoagulation and glucocorticoids. The final diagnosis was thrombus due to a paraneoplastic prothrombotic state. This case illustrates a systemic and cardiac repercussion of a hematologic disease and an unusual complication of CMR. Figure
