he features of antiphospholipid syndrome (APS) are recurrent arterial and venous thrombosis, recurrent spontaneous abortion, and thrombocytopenia. 1 Coexistence of intracardiac thrombus and pulmonary embolism in APS is relatively rare. 2,3 We report a patient with this condition whose initial presentation of shortness of breath.
Case ReportA 22-year-old woman was diagnosed with atrial septal defect (secundum type) and underwent surgical repair in 1994. Her general condition was good after the surgery. She denied any intravenous drug abuse or tobacco use, and there was no known family history of thrombotic disease. Three days before the present admission, she had shortness of breath and a dry cough, and she presented at the emergency room for further evaluation. On examination, she was in respiratory distress, with tachypnea (27 breaths/min), blood pressure of 146/84 mmHg, tachycardia (133 beats/min), and body temperature measuring 36.8°C. The jugular vein was not engorged, and cardiac auscultation revealed a grade II/VI systolic murmur over the right lower sternal border. Chest auscultation showed mild fine crackles over both of the lower lung fields. Arterial blood gas analysis under oxygen 2 L/min revealed pH of 7.486; pO2, 87 mmHg; pCO2, 28.8 mmHg, and bicarbonate 21.3 mmol/L. There was sinus tachycardia without significant ST-T segment change on the electrocardiogram, and chest X-ray did not show any remarkable findings. However, transthoracic echocardiography showed a floating mobile mass adhered to the free wall of the right atrium by a slender stalk closely attached to the interatrial septum. This lesion was intermittently protruding into the right ventricle during diastole (Fig 1A,B). There was neither a morphological abnormality nor vegetative formation on the valves, although tricuspid regurgitation was observed. Subsequent chest computed The presence of antiphospholipid antibodies is associated with arterial and venous thrombosis. A young female with initial presentation of dyspnea and cough that lasted for days is reported. A computed tomographic scan of her chest and echocardiography showed features of thrombus formation over the right atrium, complicated with pulmonary thromboembolism. Antiphospholipid syndrome was diagnosed according to elevated activated partial thromboplastin time, high serum titers of anticardiolipin antibody, and the presence of intracardiac thrombus with pulmonary embolism. This thrombus was subsequently removed successfully with surgical intervention, and the patient's recovery was uneventful. (Circ J 2005; 69: 1290 -1292
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