European Heart Journal Advance Access originally published online on March 6, 2008
European Heart Journal 2008 29(16):1955; doi:10.1093/eurheartj/ehn084
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Radiopaque thrombus in right ventricle
Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr University Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany
* Corresponding author. Tel: +49 5731 971 258, Fax: +49 5731 972 194, Email: mlange{at}hdz-nrw.de
A 75-year-old woman presented with mild dyspnoea over 3 months. Nine months before she had been treated for pneumonia associated with septicaemia in an intensive care setting. Percutaneous vertebroplasties had been performed following osteoporotic fractures of several vertebrae 5 months earlier.
Transthoracic echocardiography displayed a thready foreign body in the right ventricle reaching the right pulmonary artery (Panel A). Chest X-ray revealed a radiopaque thread-like structure (Panel B). Entertaining suspicion that the foreign body was a dislocated catheter cardiac catheterization of right heart was performed. The structure turned out to be elastic and ruptured while attempting to retrieve it with a goose-neck-snare catheter (Panel C). Because of the morphology of the gathered fragment, a dislocated wire or a catheter could be excluded (Panel D). Histological examination showed a thrombus with a tubular structure (Panel E). Computerized tomography of the lumbar vertebral column displayed perivertebral veins filled with acrylic cement after vertebroplasty (Panel F). Histological examination revealed the thready foreign body to be a thrombus, but the fact that it is radiopaque was unexplained. Cement leakage into the perivertebral venous system is an often reported complication after vertebroplasty. In this case, the acrylic bone cement triggered the generation of a tubular thrombus around the leaked material. The thrombus was radiopaque because of integrated polymers of the acrylic bone cement. In histological examination, the polymers were not detected because they were removed by the preparation with Xylol (part of the haematoxylin–eosin stain). The prepared fragment was no longer radiopaque (Panel G).
The patient reported about a spontaneous decline of dyspnoea. Heart surgery to remove the thrombus was not considered because of concomitant morbidities. Anticoagulation with phenprocoumon was initiated.
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