Coronary Embolism Caused by Massive Intraventricular Thrombus in a Young Patient with Thrombophilia and Drug-Induced Dilated Cardiomyopathy
Categoria dell'articolo: Case Report
Pubblicato online: 01 lug 2025
Pagine: 83 - 87
Ricevuto: 12 mar 2025
Accettato: 02 giu 2025
DOI: https://doi.org/10.2478/jce-2025-0009
Parole chiave
© 2025 Ciprian Grigoroaea et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
Introduction
Cardiac thrombi are often incidental findings on cardiac imaging and typically appear as uniform echo-densities. They develop in areas of blood flow stasis, particularly in structurally abnormal chambers such as in dilated cardiomyopathy. Their differential diagnosis includes vegetations and tumors, therefore accurate identification is critical for appropriate management.
Case Presentation
We present the case of a 27-year-old male patient with a history of smoking and drug use, admitted for dyspnea and fatigue. Echocardiography revealed globally dilated chambers with severe apical hypokinesia and a large echogenic mass in the left ventricle. Laboratory investigations showed elevated hs-cTnI, NT-proBNP, and D-dimer levels. Coronary angiography demonstrated a subocclusive stenosis in the left anterior descending artery, likely from a partially recanalized thrombus, and was treated with angioplasty and drug-eluting stent placement. The thrombophilia panel revealed minor thrombophilia: MTHFR A1298C (homozygous), EPCR (A1/A2 Allele), Factor XIII and PAI-1 (heterozygous). The patient was managed conservatively with anticoagulation, heart failure therapy, and percutaneous coronary intervention. Follow-up showed a two-thirds reduction in thrombus size and stable status.
Conclusions
This case highlights the importance of considering inherited thrombophilia in young patients presenting with intracardiac thrombus. For favorable outcomes, assessment of underlying thrombophilia, a combination of appropriate anticoagulation and interventional therapies are essential.