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A Jellyfish Thrombus
IMAGE
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A Jellyfish Thrombus F. Alsemgeest, MD, R. Nijveldt, MD, PhD and F. Nijland, MD, PhD ∗ Department of Cardiology, St. Lucas Andreas Hospital, Amsterdam, The Netherlands
A
62 year-old patient presented with a painful right leg at the emergency department. Her medical history revealed persistent atrial fibrillation and congestive heart failure. The patient was on adequate warfarin treatment. At physical examination, she had a cold right leg without pulsations and a discoloured and patched skin.
the left atrial appendage. Panel C (Fig. 1) shows a threedimensional image of the left atrial structure (arrow). A few hours later, the patient suddenly died. Autopsy showed a large haematoma in the right groyne, expanding to the abdomen and right upper leg with an estimated blood loss of 3 L. Furthermore, the right exter-
Fig. 1.
The patient was treated with urokinase for an occluded superficial femoral artery. The procedure was complicated by a right groyne haematoma. After reperfusion, there was hypotension and poor diuresis. The cardiologist was consulted. Transthoracic echocardiography demonstrated markedly dilated left atrium with an atypical mobile mass. The patient underwent transoesophageal echocardiography, which revealed a deforming jellyfish-like structure in the left atrium connected to the inter-atrial septum (Fig. 1, panels A and B, arrow), and a thrombus in Received 20 September 2010; accepted 10 January 2011; available online 12 February 2011 ∗
Corresponding author. Tel.: +31 20 5108135; fax: +31 20 6830165. E-mail address: [email protected] (F. Nijland).
nal iliac artery was completely occluded and fresh thrombi were found in the left carotid artery, the left atrium (Fig. 1, panel D, arrow) and its appendage. This case describes a fatal course of a patient with massive embolisation of cardiac origin despite adequate anticoagulation, who died because of a major side effect of thrombolysis. However, it beautifully demonstrates the echocardiographic appearance of a fresh atrial thrombus, in comparison to a chronic thrombus which is more homogenous and solid.
Appendix A. Supplementary data Supplementary data associated with this article can be found, in the online version, at doi:10.1016/j. hlc.2011.01.008. 1443-9506/04/$36.00 doi:10.1016/j.hlc.2011.01.008
Image
A Jellyfish Thrombus F. Alsemgeest, MD, R. Nijveldt, MD, PhD and F. Nijland, MD, PhD ∗ Department of Cardiology, St. Lucas Andreas Hospital, Amsterdam, The Netherlands
A
62 year-old patient presented with a painful right leg at the emergency department. Her medical history revealed persistent atrial fibrillation and congestive heart failure. The patient was on adequate warfarin treatment. At physical examination, she had a cold right leg without pulsations and a discoloured and patched skin.
the left atrial appendage. Panel C (Fig. 1) shows a threedimensional image of the left atrial structure (arrow). A few hours later, the patient suddenly died. Autopsy showed a large haematoma in the right groyne, expanding to the abdomen and right upper leg with an estimated blood loss of 3 L. Furthermore, the right exter-
Fig. 1.
The patient was treated with urokinase for an occluded superficial femoral artery. The procedure was complicated by a right groyne haematoma. After reperfusion, there was hypotension and poor diuresis. The cardiologist was consulted. Transthoracic echocardiography demonstrated markedly dilated left atrium with an atypical mobile mass. The patient underwent transoesophageal echocardiography, which revealed a deforming jellyfish-like structure in the left atrium connected to the inter-atrial septum (Fig. 1, panels A and B, arrow), and a thrombus in Received 20 September 2010; accepted 10 January 2011; available online 12 February 2011 ∗
Corresponding author. Tel.: +31 20 5108135; fax: +31 20 6830165. E-mail address: [email protected] (F. Nijland).
nal iliac artery was completely occluded and fresh thrombi were found in the left carotid artery, the left atrium (Fig. 1, panel D, arrow) and its appendage. This case describes a fatal course of a patient with massive embolisation of cardiac origin despite adequate anticoagulation, who died because of a major side effect of thrombolysis. However, it beautifully demonstrates the echocardiographic appearance of a fresh atrial thrombus, in comparison to a chronic thrombus which is more homogenous and solid.
Appendix A. Supplementary data Supplementary data associated with this article can be found, in the online version, at doi:10.1016/j. hlc.2011.01.008. 1443-9506/04/$36.00 doi:10.1016/j.hlc.2011.01.008