Serpentine Thrombus of the Right Cavities of the Heart Extending to the Trunk of the Pulmonary Artery Complicating a Uterine Leiomyosarcoma without Pulmonary Embolism: Case Report
Published: 2022-11-08
Page: 302-307
Issue: 2022 - Volume 5 [Issue 1]
L. Laklalech
Department of Cardiology, P37, Ibn Rochd University Hospital, Casablanca, Morocco.
M. Njie *
Department of Cardiology, P37, Ibn Rochd University Hospital, Casablanca, Morocco.
A. Abourich
Department of Cardiology, P37, Ibn Rochd University Hospital, Casablanca, Morocco.
M. Belhakim
Department of Cardiology, P37, Ibn Rochd University Hospital, Casablanca, Morocco.
M. Haboub
Department of Cardiology, P37, Ibn Rochd University Hospital, Casablanca, Morocco and Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco.
S. Arous
Department of Cardiology, P37, Ibn Rochd University Hospital, Casablanca, Morocco and Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco.
Med G. Bennouna
Department of Cardiology, P37, Ibn Rochd University Hospital, Casablanca, Morocco and Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco.
A. Drighil
Department of Cardiology, P37, Ibn Rochd University Hospital, Casablanca, Morocco and Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco.
L. Azzouzi
Department of Cardiology, P37, Ibn Rochd University Hospital, Casablanca, Morocco and Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco.
R. Habbal
Department of Cardiology, P37, Ibn Rochd University Hospital, Casablanca, Morocco and Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco.
*Author to whom correspondence should be addressed.
Abstract
Serpentine thrombus or snake like floating thrombus of the right-side cavities of the heart is a rare diagnosis. Its an extreme emergency, and is often fatal due to the migration of small thrombus which can completely obstruct the pulmonary trunk. Advanced cancer disease is one of the rare causes of this diagnosis. Two-dimensional transthoracic echocardiography helps to confirm the diagnosis while Angio CT-Scan confirms the presence of pulmonary embolism in patients presenting acute or aggravative dyspnea. Treatment may involve surgical thrombectomy or intravenous thrombolysis but the use of medical treatment alone (that is oral or subcutaneous injectable anticoagulants) has never been an effective choice of therapy except in exceptional cases.
We report a rare case of a patient followed at the oncology department for locally advanced uterine leiomyosarcoma under chemotherapy who presented aggravating symptom of dyspnea at the emergency department where a serpentine thrombus was diagnosed by transthoracic echocardiography. Angio computed tomography scan (Angi-CT SCAN) showed no signs of pulmonary embolism in the patient who finally was placed on low molecular weight heparin (LMWH) due to high bleeding risk with a good outcome under strict hospital surveillance. This case reflects the difficulty of therapy strategies in some population of patients with high risk of mortality due to the presence of floating thrombus associated with high bleeding risk.
Keywords: Serpentine thrombus, uterine leiomyosarcoma, pulmonary embolism
How to Cite
Downloads
References
Vidyashree Hulkoti, Sandeep Kamat, Sourya Acharya, Samarth Shukla, Sunil Kumar, Dhruv Talwar. Serpentine Thrombus in Right Atrium: A Tell-Tale Sign of Venous Thromboembolism. Cureus. 2021 Dec 10;13:e20336.
Bagga C, Ansari I, Garikapathi A, Irshadvs, Naik S, Agrawal S, Kumar S. Status epilepticus presenting feature of pulmonary embolism: rarest of rare combination. Med Sci. 2020;24:3277-80.
Elizabeth M Johnson, Kenneth L Gage, Sebastian Feuerlein, Daniel Jeong. Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques. J Vis Exp. 2019;11;148.
Ingolf Juhasz-Böss, Lena Gabriel, Rainer M Bohle, Lars C Horn, Erich-Franz Solomayer, Georg-Peter Breitbach. Uterine Leiomyosarcoma. Oncol Res Treat. 2018; 41(11):680-686.
Peng YJ, Hueng GG, Lee HS. Acute heart failure as manifestation of metastatic uterine leiomyosarcoma to the heart and lung. Heart Lung. 2004;33; 46-9.
Farfel Z, Shechier M, and al. Review of echocardiographically diagnosed right heart entrapment of pulmonary emboli-in-transit with emphasis on management. Am Heart J. 1987; 117:171-178.
Gras D, Bedossa M, Lehelloco A, et al. Thrombose auriculaire droite et embolie pulmonaire grave. Arch Mal Cœur. 1992; 85:253-256,
Taupin JM, Chapoutot L, Metz D, et al. Thrombus flottant de l'oreillette droite dans l'embolie pulmonaire aigue. Aspects chroniques, écho cardiographiques et incidences thérapeutiques. Ann Cardiol Angéiol. 1988;37:243-247.
Benichou M, Bernard P J, Sarrat P, et al. Détection des caillots intracardiaques par la scintigraphie aux plaquettes marquées à l'indium 111 Confrontation avec l’échographie bidimensionnelle et la scanographie cardiaque. Arch Mal Cœur. 1984;77:1054-1063.
Agnes Mayr, Gert Klug, Simon Greulich, Bernhard Metzler, Gudrun Feuchtner. Serpentine-like right atrial mass and fulminant bilateral pulmonary embolism during treatment with rivaroxaban. Int J Cardiovasc Imaging. 2016;3:1001-2.
D. Attias, E. Abitbol, S. Russel, J. Paziaud, P. Lim, C. Roiron, J.-L. Monin, P. Guéret, J. Garot Thrombus serpentin récidivant des cavités cardiaques droites. Presse Med. 2005;34:1337.
Yastrebov K, Brunel L, Paterson HS, Williams ZA, Bannon PG. Three dimensional intracardiac echocardiography and pulmonary embolism. Cardiovasc Ultrasound. 2020 Aug 20;18(1):36.
Felner JM, Churchwell AL, Murphy DA. Right atrial thromboemboli: Clinical, echocardiographic and pathologic manifestations. J Am Coll Cardiol. 1984;4: 1041-1051.
Patnaik S, Rammohan HS, Shah M, Garg S, Figueredo V, Janzer S, Shah S. Percutaneous Embolectomy of Serpentine Thrombus from the Right Atrium in a 51-Year-Old Man. Tex Heart Inst J. 2016 Dec 1;43:524-527.
Rosenfeld BL, Bashir R, Brisco-Bacik MA, Panidis IP, Vaidya A, Minakata K, Forfia PR. Leiomyosarcoma Tumor Embolism Masquerading as Thrombus in Transit. Am J Case Rep. 2020;29;921124.
Corman C, Roudaut R, Gosse P, et al. Thromboses de l'oreillette droite: Aspect échocardiographies, conduite pratique. A propos de 8 cas. Arch Mal Cœur. 1986; 79:464-471.