case_images: PMC11249738_01
case_images: Echocardiogram from Pingguo People's hospital shows biatrial thrombosis. (A) Parasternal long-axis section; (B) apical four-chamber view. The red arrow points to the left thrombus in the left atrium; the green arrow points to the right atrium thrombus.
case_images: fcvm-11-1409775-g001.jpg
case_images: PMC11249738_01_fcvm-11-1409775-g001.jpg
case_images: F1
case_images: The patient had been admitted to a local hospital due to fever and syncope 2 days previously, where echocardiogram findings indicated an enlargement of the right atrium and ventricle and thrombi within both the left and right atria (Figure 1). T wave changes. Echocardiography showed a left atrial anteroposterior diameter of 26 mm, a right atrial anteroposterior diameter of 46 mm, a left ventricular end-diastolic diameter of 40 mm, a right ventricular anteroposterior diameter of 23 mm, a left ventricular ejection fraction of 54%, thrombi in both atria, severe pulmonary arterial hypertension (70 mmHg), and an atrial septal defect width of approximately 4.1 mm (Figure 2, Table 1). Thrombosis formation was seen in the bilateral popliteal veins (complete occlusion).
case_images: Echocardiogram shows biatrial thrombosis, atrial defect or patent foramen ovale. (A) Apical four-chamber view, biatrial thrombus; (B) apical four-chamber view, small atrial defect or patent foramen ovale; (C) four-chamber heart view of the xiphoid process, atrial defect or patent foramen ovale.
case_images: fcvm-11-1409775-g002.jpg
case_images: PMC11249738_01_fcvm-11-1409775-g002.jpg
case_images: F2
case_images: T wave changes. Echocardiography showed a left atrial anteroposterior diameter of 26 mm, a right atrial anteroposterior diameter of 46 mm, a left ventricular end-diastolic diameter of 40 mm, a right ventricular anteroposterior diameter of 23 mm, a left ventricular ejection fraction of 54%, thrombi in both atria, severe pulmonary arterial hypertension (70 mmHg), and an atrial septal defect width of approximately 4.1 mm (Figure 2, Table 1). Thrombosis formation was seen in the bilateral popliteal veins (complete occlusion).
case_images: Pulmonary artery CT angiography results when the patient was hospitalized. (A) The red arrow points to the filling defect of the right pulmonary artery; (B) the red arrow points to the filling defect of the left pulmonary artery; (C) the red arrow points to the space in the right atrium; (D) the red arrow points to the space in the left atrium.
case_images: fcvm-11-1409775-g003.jpg
case_images: PMC11249738_01_fcvm-11-1409775-g003.jpg
case_images: F3
case_images: Pulmonary artery CT angiography indicated bilateral multiple PEs and intra-atrial occupying lesions in both atria (Figure 3).
case_images: Preoperative and postoperative results of patient's catheterization laboratory interventional surgery. (A) Right pulmonary artery thrombus removal; (B) left pulmonary artery thrombus removal; (C) pulmonary angiography before interventional treatment; (D) arrow pulmonary angiography after interventional treatment.
case_images: fcvm-11-1409775-g004.jpg
case_images: PMC11249738_01_fcvm-11-1409775-g004.jpg
case_images: F4
case_images: Postoperative reexamination with angiography revealed that the main trunks of both the left and right pulmonary arteries had regained patency, the filling defect had markedly improved, and the main branches of both lungs were revisualized, with increased perfusion in both lungs compared to before (Figure 4).
case_images: No intracardiac thrombus was found on the echocardiogram of the patient on the first postoperative day. (A) Four-chamber heart in the apical region; (B) five-chamber heart in the apical region.
case_images: fcvm-11-1409775-g005.jpg
case_images: PMC11249738_01_fcvm-11-1409775-g005.jpg
case_images: F5
case_images: (A) Indicators of infection showed a downward trend; (B) coagulation parameters showed an improvement trend; (C) organ dysfunction showed an improvement trend; (D) lupus anticoagulant present in plasma, on >=2 occasions at least 12 weeks apart.
case_images: fcvm-11-1409775-g006.jpg
case_images: PMC11249738_01_fcvm-11-1409775-g006.jpg
case_images: F6
case_images: After comprehensive multidisciplinary treatment from the intensive care, cardiology, and interventional departments, the patient's indicators of infection decreased (Figure 6A), cardiac contractile function gradually improved, and his hemodynamics stabilized. The anticoagulation treatment was then adjusted to rivaroxaban, glucocorticoids, and cyclophosphamide were added, multiple organ functions exhibited progressive improvement (Figures 6B,C).
case_images: (A) Fingers show livedo reticularis and necrosis; (B) 6 months later, fingers show no significant livedo reticularis and necrosis.
case_images: fcvm-11-1409775-g007.jpg
case_images: PMC11249738_01_fcvm-11-1409775-g007.jpg
case_images: F7
case_images: The patient's fingers showed livedo reticularis and necrosis (Figure 7A), and enoxaparin was continued. At the 6-month post-discharge follow-up, the patient reported no discomfort during daily activities, fingers showed no significant livedo reticularis and necrosis (Figure 7B), and laboratory tests, including NT-proBNP and D-dimer, were all within normal ranges.
case_images: The patient's pulmonary artery CT angiography showed less embolism on the 15th postoperative day than before. (A) Slight filling defect in the right pulmonary artery; (B) slight filling defect in the left pulmonary artery; (C, D), the chambers are now mainly patent with maybe minor wall-adherent residuals.
case_images: fcvm-11-1409775-g008.jpg
case_images: PMC11249738_01_fcvm-11-1409775-g008.jpg
case_images: F8
case_images: Reexamination of the pulmonary artery angiography on the 15th day indicated that the main pulmonary artery, the left and right pulmonary artery trunks, multiple lobes of both lungs, and segmental arteries showed patchy, cast-like, low-density filling defects, significantly reduced compared to before, and no abnormally thickened or twisted vascular mass was observed (Figure 8).