Intra Cardiac Free-Floating Microthrombi and Pericarditis in the Setting of Covid 19: An Unusual Mix!

Abstract

Background: The coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (sarscov2), has been shown to cause conventional respiratory distress, in addition to that, there has been recent reports suggesting the cardiovascular system involvement during the course of the infection, including microthrombosis and cardiopulmonary serosal layers infection and inammation although being separately described. The present paper demonstrates the rst reported case of the concomitant presence of intra-cardiac free- oating microthrombi and pericardial effusion secondary to COVID-19 infection, beyond the casual clinical presentation. Case report :A 51 year-old man with no medical history, presented to the emergency department, with a progressively worsening dyspnea, he had an oxygen saturation of 85% on rst medical contact. The chest radiography and the baseline ECG showed respectively multifocal bilateral patchy opacities and a sinus tachycardia with low QRS voltage and t wave inversion in all leads. On further assessment, the echocardiography revealed the presence of free-oating microthrombi in the right atrium and a moderate pericardial effusion. Biological ndings and pulmonary computed tomography were suggestive of sarscov2 infection. Interestingly, there was no evidence of pulmonary embolism. The patient, thus, received heparin therapy and colchicine. We noted a rapid improvement in the following seven days, the hospital discharge was, hence, deemed warranted. Conclusions: This case highlights an unusual presentation of COVID-19 infection, the diagnostic and therapeutic challenges we are facing in this setting. Moreover, it raises the question about the emergent need of a therapeutic regimen, in order to better manage this unique condition and a fortiori mitigate the COVID-19 complications.