■原位右心房(RA)血栓是一种罕见的发生,通常与炎症或高凝状态升高有关。这里,我们介绍了一例在脓毒症和菌血症患者中模拟心房黏液瘤的原位RA血栓病例.
■一名41岁的男子出现由耐甲氧西林金黄色葡萄球菌(MRSA)引起的脓毒性关节炎和菌血症。经食管超声心动图显示有一个类似心房粘液瘤的大的带蒂肿块,在四天前进行的经胸超声心动图检查中看不到。心脏磁共振(CMR)成像强烈提示血栓,导致患者接受经导管抽吸。随后的病理证实有组织的纤维蛋白血栓,没有感染的证据。
■患者的原位RA血栓可能是对与脓毒症相关的高度炎症状态的反应。在没有房颤的情况下,关于原位RA血栓的数据有限,尽管一些报告表明炎症加剧与高凝状态之间存在相关性。
■CMR成像对于表征此类肿块非常有价值,并且可以帮助区分血栓和粘液瘤。
结论:区分右心房(RA)血栓和粘液瘤:心脏磁共振成像对于区分RA血栓和粘液瘤至关重要,避免不必要的手术。高凝状态和炎症状态:自发性原位RA血栓可在没有深静脉血栓(DVT)或心房颤动的情况下发生,尤其是在高凝和炎症条件。经导管抽吸:这种侵入性较小的替代手术对大型手术有效,移动式RA血栓,降低栓塞风险。
UNASSIGNED: In-situ right atrial (RA) thrombus is a rare occurrence typically associated with heightened inflammatory or hypercoagulable states. Here, we present a case of in-situ RA thrombus mimicking atrial myxoma in a patient with sepsis and bacteraemia.
UNASSIGNED: A 41-year-old man presented with septic arthritis and bacteraemia caused by methicillin-resistant Staphylococcus aureus (MRSA). A transoesophageal echocardiogram revealed a large pediculated mass resembling atrial myxoma, which was not visible on transthoracic echocardiography performed four days earlier. Cardiac magnetic resonance (CMR) imaging strongly suggested a thrombus, leading to the patient undergoing transcatheter aspiration. Subsequent pathology confirmed an organised fibrin thrombus without evidence of infection.
UNASSIGNED: The patient\'s in-situ RA thrombus likely developed in response to a heightened inflammatory state associated with sepsis. Limited data exist on in-situ RA thrombi in the absence of atrial fibrillation, though some reports suggest a correlation between heightened inflammation and a hypercoagulable state.
UNASSIGNED: CMR imaging is invaluable for characterising such masses and can aid in distinguishing a thrombus from a myxoma.
CONCLUSIONS: Differentiating right atrial (RA) thrombus from myxoma: cardiac magnetic resonance imaging is essential for distinguishing RA thrombus from myxoma, preventing unnecessary surgeries.Hypercoagulable and inflammatory states: spontaneous in-situ RA thrombi can occur without deep vein thrombosis (DVT) or atrial fibrillation, especially in hypercoagulable and inflammatory conditions.Transcatheter aspiration: this less invasive alternative to surgery is effective for large, mobile RA thrombi, reducing embolisation risk.