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Idiopathic massive left ventricular thrombus in HIV patient
© Homer et al.; licensee BioMed Central Ltd. 2012
Received: 16 February 2012
Accepted: 16 June 2012
Published: 4 July 2012
A 47-year old man with HIV presented with a stroke. Imaging revealed a large mobile left-ventricular thrombus. The mass was resected using a small ventriculotomy with good early postoperative prognosis. Thrombus etiology is likely related to HIV pathology.
LV thrombi typically occur in the case of impaired LV dysfunction as a result of dilated cardiomyopathy, aneurysm or a myocardial infarction . However a thrombus of this size is uncommon, particularly in a patient under 50 years of age with no known cardiac disorder. Because mobile thrombi have a significantly higher risk of embolism than mural thrombi, surgical excision is often indicated .
A 47-year old man with HIV presented with a stroke. Upon workup, he was found to have a large mobile cardiac mass in his left ventricle.
A thrombus of this size is uncommon, particularly in a patient under 50 years of age with no known cardiac disorder. The patient’s positive HIV status is a possible risk factor for general thromboembolism and microembolism of the coronary circulation. HIV and AIDS are known to be associated with various abnormalities predisposing patients to a hypercoagulable state [3–6]. These pathologies in this HIV positive patient may explain the small myocardial infarct, large thrombus formation and subsequent stroke.
The management of LV thrombi is often restricted to anticoagulant and thrombolytic therapy . However, surgery is indicated in cases with an elevated risk for embolism or for large thrombi where thrombolysis will likely increase risk of embolism [2, 7]. This particular patient fit both of those criteria, with a previous stroke and large, mobile thrombus, warranting surgical removal. As the life expectancy in HIV patients continues to improve, this situation may arise again in the future. Other patients may benefit from this approach.
Written informed consent was obtained from the patient for publication of this Case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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