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Intracardiac thrombus with lower limb arterial thrombus

Case contributed by Karen Machang'a
Diagnosis almost certain

Presentation

Sudden onset of right lower limb numbness and coldness.

Patient Data

Age: 40 years
Gender: Male

Lower limb arterial Doppler:

  • An intraluminal thrombus is seen in the popliteal artery measuring 0.9 cm x 0.5 cm, occluding approximately 95% of the vessel.

Echocardiography :

  • An echo-dense mass with well-demarcated margins distinct from the endocardium is seen throughout the cardiac cycle on the left ventricular apex consistent with a left ventricular apical clot.

  • Normal-sized left ventricle with global left ventricular wall hypokinesia and impaired systolic function, LVEF 20 %.

  • Moderate mitral regurgitation.

Case Discussion

Left ventricular thrombus is a serious complication of acute myocardial infarction and non-ischemic cardiomyopathies. It is associated with an increased risk of systemic embolism, stroke, cardiovascular events and death.

The above patient most likely had the left ventricular thrombus dislodge to the systemic circulation and ended up occluding the right popliteal artery.

Co-author; Catherine Nyambura

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