Primary antiphospholipid syndrome (APS) is a well-defined entity characterized by spontaneous
and recurrent abortion, thrombocytopenia and recurrent vascular thromboses (arterial
and venous). Left ventricular thrombus mimicking primary cardiac tumor with recurrent
systemic embolism has not been previously reported.
In this report we describe a 39 year-old man admitted to hospital presenting with left hemiparesis
and a peripheral embolism. He had no history of thrombotic events. Transthoracic
echocardiography showed a large, polypoid and mobile mass (4.0 × 1.2 cm) attached to the
apex of the left ventricle, highly suggestive of primary cardiac tumor. The patient subsequently
underwent open heart surgery. The histological examination showed an older thrombus and
a fresh thrombus. Post-operative laboratory tests showed lupus anticoagulant activity, confirming
the primary APS diagnosis. The patient initiated treatment with oral anticoagulation
(INR levels between 2 and 3) and was discharged 29 days after surgery. At ten month follow-up, he was symptom-free with long-term anticoagulation therapy. No evidence of intracardiac
mass recurrence on two-dimensional echocardiography was seen.
Intracardiac thrombus has been rarely reported as a complication of primary APS. Left ventricular
mass mimicking primary cardiac tumor with recurrent systemic embolism has not
been previously reported. Pre-operative investigations could not distinguish such a thrombus
from a cardiac tumor and the diagnosis was made post-operatively
