Unusual Biventricular Thrombus Formation in Acute Myeloid Leukemia and Factor V Leiden Mutation
A 27-year-old woman was admitted with acute deep vein thrombosis. Hematologic studies revealed anemia, with a hemoglobin level of 11g/dL, a lactic dehydrogenase level of 575 U/L, thrombocytopenia (73 platelets/nL), leukocytosis (188 white blood cells/nL), and peroxidase-negative acute hemoblastosis (a peripheral blood smear with 95% of blasts). Bone marrow biopsy confirmed the diagnosis of acute myeloid leukemia. Further laboratory evaluation was notable for a heterozygous Factor V Leiden mutation. Before chemotherapy, and for evaluation of the cardiac status, transthoracic echocardiography was performed. A biventricular thrombus formation was detectable (Figure 1, video clips A through D). After use of an intravenous ultrasound contrast agent (Optison), the regional signal intensity of the thrombi was unchanged (Figure 2, video clips A and B). Cardiac magnetic resonance imaging (Siemens Magnetom) confirmed the suspicion of intraventricular thrombus formation (Figure 3). After three cycles of polychemotherapy and anticoagulation with heparin, the left ventricular mass decreased, while the right ventricular thrombus remained unchanged (Figure 4, video clips A and B). In the long term, a bone marrow transplantation and anticoagulation with coumarin are scheduled.
Video clips are available in an online-only Data Supplement at http://www.circulationaha.org.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.