Multiple Sizeable Left Ventricular Thrombi in a Patient with Anti-Phospholipid Syndrome

 Eunice Chuah   Christopher Alan Brooks   Ferris Touma   George Lau

Abstract

Left ventricular thrombus is a morbid complication most often associated with a large territory myocardial infarction. In the present study, we describe a middle-aged male patient presenting acutely with bilateral lower limb ischaemia, secondary to thrombo-emboli and treated with embolectomy. Further investigation revealed precocious coronary artery disease and multiple large left ventricular thrombi, out of proportion to an underlying small region of myocardial infarction. Transient neurological symptoms prompted cerebral magnetic resonance imaging and were determined to be the manifestations of repeated cardio-embolic stroke. Screening for an occult cause of thrombophilia revealed undiagnosed anti-phospholipid syndrome. In this study, we discuss the relevant diagnostic and therapeutic considerations. This case is especially novel in terms of its echocardiography, coronary angiography, and cardiac magnetic resonance imaging. We discuss the choice of anticoagulation as rationalised by the contemporary literature, and the means by which patients are stratified for therapy, in patients with left ventricular thrombus and/or anti-phospholipid syndrome.