A Rare Case of Splenic Infarct Secondary to Mobile Cardiac Echodensity.
aortic echodensity
cardiac embolism
lambl
oral anticoagulation
splenic infarct
transesophageal echo
Journal
Cureus
ISSN: 2168-8184
Titre abrégé: Cureus
Pays: United States
ID NLM: 101596737
Informations de publication
Date de publication:
Oct 2023
Oct 2023
Historique:
accepted:
03
10
2023
medline:
6
11
2023
pubmed:
6
11
2023
entrez:
6
11
2023
Statut:
epublish
Résumé
Lambl's excrescences (LE) are mobile filiform lesions, mostly found on the left-sided heart valves. Histologically, they have a mesenchymal origin with a single endothelial layer. They have the potential to detach, resulting in catastrophic thromboembolic events. Their rarity often leads to them being misdiagnosed as vegetations of endocarditis with patients failing to improve on conventional therapy. A 48-year-old female with a history of hypertension presented to the Emergency Department with a one-week history of sharp left upper quadrant pain. She was vitally stable; the only lab abnormality was revealed to be a mildly elevated white cell count. CT abdomen revealed a splenic infarct involving 25% of the parenchyma. Patients had no history of abdominal trauma, coagulation disorders, exogenous estrogen use or IV drug abuse. Subsequent investigations failed to reveal any cause of hypercoagulability. An extensive cardiac workup revealed no arrhythmias, but transesophageal echocardiogram showed a mobile echo density on the ventricular side of the aortic valve attached at the coaptation zone, approximately 2.7 cm long and 0.1 cm wide, suggesting a very prominent Lambl's excrescence. In the absence of any other findings, the patient's splenic infarct was determined to be secondary to an embolic event from the aortic valve lesion. Rivaroxaban was initiated and the patient subsequently improved. Existing literature describes most LEs as being asymptomatic and discovered incidentally on echocardiograms. This case illustrates the need to develop a criterion for prompt identification of LEs and differentiating them from the vegetations of endocarditis. It also brings forth the question of prophylactic treatment of these lesions while highlighting the lack of guidelines regarding the management of embolic phenomena secondary to LE.
Identifiants
pubmed: 37927647
doi: 10.7759/cureus.46434
pmc: PMC10622253
doi:
Types de publication
Case Reports
Langues
eng
Pagination
e46434Informations de copyright
Copyright © 2023, Ramanan et al.
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Echocardiography. 2007 Nov;24(10):1086-9
pubmed: 18001363
BMJ Case Rep. 2013 Dec 05;2013:
pubmed: 24311417
J Am Coll Cardiol. 1997 Nov 1;30(5):1308-14
pubmed: 9350932
Echocardiography. 2000 Jan;17(1):101-3
pubmed: 10978966
Circulation. 1999 Apr 13;99(14):1919-21
pubmed: 10199892
Arch Mal Coeur Vaiss. 1996 Nov;89(11):1419-23
pubmed: 9092401
J Heart Valve Dis. 2010 Sep;19(5):669-70
pubmed: 21053748
Am J Case Rep. 2015 Dec 14;16:876-81
pubmed: 26655393
Rev Neurol (Paris). 1995 Oct;151(10):583-5
pubmed: 8594653
An Med Interna. 2006 Apr;23(4):181-3
pubmed: 16796413
J Clin Neurosci. 2013 Nov;20(11):1632-4
pubmed: 23669170
Nervenarzt. 2006 Dec;77(12):1492-4
pubmed: 17102989
J Am Coll Cardiol. 1995 Dec;26(7):1709-12
pubmed: 7594107
J Pathol Bacteriol. 1949 Apr;61(2):203-8, 5 pl
pubmed: 15392478
Chest. 1982 Apr;81(4):516-7
pubmed: 7067520
Echocardiography. 1999 May;16(4):399-414
pubmed: 11175169
Rinsho Byori. 2012 Aug;60(8):758-61
pubmed: 23198535
N Engl J Med. 2003 Dec 18;349(25):e24
pubmed: 14681522
Heart Surg Forum. 2012 Aug;15(4):E215-7
pubmed: 22917827