The presentation of a patient with a pleural effusion can range from an incidental finding to a serious condition, which can lead to being hemodynamically compromised. Here, we discuss a 24-year-old male with a history of childhood tuberculosis who presented with shortness of breath (SOB), a non-productive cough, and recent weight loss. On examination, he was dyspnoeic but alert. On echocardiographic evaluation, a massive effusion that looked like a massive pericardial effusion was seen, while a further CT scan of the thorax showed a massive unilateral left-sided pleural effusion. Although no tuberculosis (TB) was seen in the sample of thoracocentesis, the patient was referred to a TB centre because of a history of previous tuberculosis and recent weight loss. Pleural effusion and pericardial effusion can be differentiated using echocardiography. In conditions where it is impossible, further imaging, like computer tomography, may be needed to differentiate between them.
Keywords:Pleural effusion; Tuberculosis; Pericardial effusion; Cardiac tamponade
Introduction
Left ventricular thrombus (LVT) is a common complication in patients with systolic heart failure and can cause thromboembolic consequences including stroke. In order to determine the characteristics of LV thrombus among heart failure patients with reduced ejection fraction (HFrEF), the present study was undertaken.
Methods and Materials
This was retrospective cross-sectional study conducted from referral tertiary hospital in a year period. A total of 810 transthoracic echocardiograms were carried out in our center from January 2021 to December 2021. Forty participants had met the inclusion criteria of the study.
Results
About 75% of the population was male and the mean age at diagnosis was 51 years (SD: 15). Ischemic cardiomyopathy and dilated cardiomyopathy (DCMP) found to be the most underlying cause of LVT represented (57.5% and 42.5% respectively). Hypertension, hypothyroidism, and atrial fibrillation were found to be the commonest associated risk factors of LVT, 45%, 12.5%, and 30% respectively. Simpson’s Biplane’s approach yielded a mean LVEF of 25.25 ± 6.97. 60% of the patients had a LVEF of ≤25%. The mean LV end-diastolic and end-systolic diameters were 59.2 ± 9.4 mm and 51 ± 8.3mm respectively. Warfarin was administered to 19 (47.5), Rivaroxaban to 8 (20), and Dabigatran to 10 (25). The most prevalent anticoagulant among the individuals in our study was warfarin. A stroke complication was found in 8 patients (20%), two of them were hemorrhagic stroke and they were on dabigatran. A Peripheral Arterial Disease (PAD) affected 6 of the patients (15%). One of those with PAD had also ischemic stroke.
Conclusion
This study determines that Ischemic and Dilated cardiomyopathy were the most common cause of left ventricular thrombosis among HFrEF patients in Somalia.
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