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Year : 2023  |  Volume : 7  |  Issue : 1  |  Page : 65-66

Multiple Cysts or Thrombi - A Case of Masterly Disguise

Department of Non-Invasive Cardiology, Hero DMC Heart Institute, Ludhiana, Punjab, India

Date of Submission28-Jul-2022
Date of Acceptance11-Aug-2022
Date of Web Publication28-Nov-2022

Correspondence Address:
Dr. Rohit Tandon
Department of Non-Invasive Cardiology, Hero DMC Heart Institute, Ludhiana - 1410 01, Punjab
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jiae.jiae_39_22

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How to cite this article:
Tandon R, Sachdeva S. Multiple Cysts or Thrombi - A Case of Masterly Disguise. J Indian Acad Echocardiogr Cardiovasc Imaging 2023;7:65-6

How to cite this URL:
Tandon R, Sachdeva S. Multiple Cysts or Thrombi - A Case of Masterly Disguise. J Indian Acad Echocardiogr Cardiovasc Imaging [serial online] 2023 [cited 2023 May 29];7:65-6. Available from: https://jiaecho.org/text.asp?2023/7/1/65/362193

A 74-year-old female presented to the emergency room in shock after a bout of acute watery diarrhea. Her electrocardiogram showed sinus rhythm with left bundle branch block. There was no history of coronary artery disease. Preresuscitation echocardiogram showed a grossly dilated, globular-shaped left ventricle with severely reduced contractility, possibly left bundle branch block related. Cardiac enzymes showed normal troponins and elevated brain natriuretic peptide levels. Peculiar finding was the presence of multiple cystic structures attached to the left ventricular (LV) endocardium. There were four masses, all having cystic appearance, protruding into the LV cavity, having well-defined outer border and spherical shape [Figure 1], [Video 1] and [Video 2]. She was immediately resuscitated with low-dose inotropes and fluids. Diarrhea resolved spontaneously within 36 h. After stabilization, a bedside chest X-ray and ultrasound ruled out lung and hepatic cysts, respectively. Her enzyme-linked immunosorbent assay immunoglobulin G level for echinococcal serology was 6 DU (normal range 0.0–8.9 DU). Complete blood count showed total leukocyte count 4400/mm3 with 0.2% eosinophils. She refused for further investigations or treatment and was therefore, discharged on diuretics, an angiotensin converting enzyme inhibitor and an oral anticoagulant (a coumadin derivative). Twenty days later, the patient was brought for follow-up. She was asymptomatic, with no clinical evidence of heart failure or thromboembolism. Follow-up transthoracic echocardiography showed complete disappearance of the cystic masses except for single noncystic layered thrombus attached to inferior septum, suggesting the diagnosis of a large atypical multiple cystic LV thrombi [Video 3]. However, there was no improvement in LV function.
Figure 1: (a) Parasternal short-axis view of the left ventricle showing multiple cystic masses (arrows). (b) Parasternal long-axis view of the left ventricle showing large cystic mass along the posterior free wall (arrow). (c) Subcostal view of the liver showing the absence of any cyst. (d) Follow-up parasternal short- and long-axis views of the left ventricle showing the absence of cyst masses

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[Additional file 1]

Video 1: Parasternal short-axis view showing multiple cystic masses attached to left ventricular walls.

[Additional file 2]

Video 2: Three-dimensional parasternal short-axis view showing multiple cystic masses.

[Additional file 3]

Video 3: Follow-up echocardiogram showing resolution of all masses except a layered thrombus along the posterior wall with no improvement in left ventricular function.

LV thrombi may take any shape during their formation depending upon the extent of underlying LV segmental or global dysfunction and thus may be confused for cystic tumors occasionally. A therapeutic trial of oral anticoagulants for at least 3–4 weeks is justified unless contraindicated, combined with follow-up echocardiogram for regression in size of these tumor-like thrombi.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.


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