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Clinical Medical
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ISSN: 2474-3682
IMAGE ARTICLE | VOLUME 2, ISSUE 8 | OPEN ACCESS DOI: 10.23937/2474-3682/1510055

Free Floating Ball Thrombus in the Left Atrium in a Child with Restrictive Cardiomyopathy

Iyad Al-Ammouri

Department of Pediatrics, The University of Jordan, Jordan

*Corresponding author: Iyad AL-Ammouri, MD, Associate professor of pediatric cardiology, Department of Pediatrics, School of Medicine, The University of Jordan, Queen Rania street, Amman 11942, Jordan, Tel: 0096-2653-536-66 ext. 2767, Mobile: 0096-79906-0180, Fax: +96265-300-820, E-mail: alicengiz7158@gmail.com

Published: November 15, 2016

Citation: Al-Ammouri I (2016) Free Floating Ball Thrombus in the Left Atrium in a Child with Restrictive Cardiomyopathy. Clin Med Img Lib 2:055. doi.org/10.23937/2474-3682/1510055

Copyright: © 2016 Al-Ammouri I. This is an open-access content distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract


A large free floating ball thrombus was diagnosed in an 8-year-old girl with severe restrictive cardiomyopathy following transient loss of vision. The thrombus developed despite therapeutic anticoagulation. The child died two days later with a massive embolic stroke.

Idiopathic restrictive cardiomyopathy is a rare disease in children and generally has poor prognosis. The severely dilated atia, along with high incidence of atrial fibrillation results in significant risk of intra-atrial thrombosis [1]. However, free floating ball thrombus remains very rare in children. It is more common in patients with mitral valve stenosis and usually requires urgent surgical treatment [2]. Development of free floating ball thrombus was rarely reported in patients with restrictive cardiomyopathy, even in sinus rhythm [3].

An 8-year-old girl who was diagnosed with idiopathic restrictive cardiomyopathy since the age of 4 years, and has a previous stroke was followed at our institution. She was on anticoagulation with war far in with a stable international normalized ratio of 2-3. She has severe ascites for which she was treated with abdominal paracentesis on a monthly basis. She presented with transient loss of vision. Her echocardiogram showed a large free floating left atrial thrombus (Figure 1). The thrombus was bouncing off the mitral valve with each ventricular systole in supplementary material (online movie). The patient had a fatal major thromboembolic event three days after the diagnosis of the ball thrombus.


Acknowledgements


None.


Financial Support


This research received no specific grant from any funding agency, commercial, or not-for-profit sectors.


Conflict of Interest


None.

 

Figure 1: An echocardiographic image in apical view of an eight year old child with severe restrictive cardiomyopathy. There is severe dilatation of both atria, and a large ball thrombus in the left atrium measuring 2.2 cm in diameter.

References


  1. Ammash NM, Seward JB, Bailey KR, Edwards WD, Tajik J (2000) Clinical profile and outcome of idiopathic restrictive cardiomyopathy. Circulation 101: 2490-2496.

  2. Wrisley D, Giambartolomei A, Lee I, Brownlee W (1991) Left atrial ball thrombus: review of clinical and echocardiographic manifestations with suggestions for management. Am Heart J 121: 1784-1790.

  3. Tarhan H, Ocal A, Erbay AR, Yasar AS, Cicekcioglu F, et al. (2005) Free-floating left atrial ball thrombus developed in an 11-year-old child with restrictive cardiomyopathy during sinus rhythm: Manifested as a major thromboembolic event. Int J Cardiol 103: 111-113.