[HSF] Antiphospholipid Syndrome

[prasannasimha]

Hal yo did not tell us where the clot is in the "lumen" which "lumen"
I have had cases of antiphospholipid syndrome which had presented as 
masses and pot hoc on HPE came as clot. These patients should be managed 
by anticoagulation and those masses actually disappear. One case had a 
mass in the LVOT. He stopped anticoagulation and the mass started to 
reappear (I had excised it) in the small spot of excision and restarting 
anticoagulation caused it to disappear !! I would biopsy him 
anticoagulate him well for a couple of months under close observation 
and reassess. You may not need surgery at all !!

Prasanna

Hgrmd at aol.com wrote:
> Dear Members:
>   I need some advice on how to handle this case.  This 47 yo man  was 
> admitted with gangrenous toes.  He had palpitations secondary to atrial  flutter.  
> His past history was significant for DVT for which he had been on  Coumadin.  No 
> h/o PE.  Workup in the past had apparently supported the  diagnosis of 
> antiphospholipid syndrome.  
>   I'm not quite sure why, but he ended up with a contrast chest  CT.  It 
> revealed lamination of apparent clot that concentrically occupied  2/3's of the 
> lumen.  They did a TEE which was consistent with the CT.   There were no 
> significant valvular abnormalities.  The RV functioned  well.   There was only trace 
> TR.  
>   My working diagnosis is that the poor guy has a bunch of laminated  clot in 
> the RA. I was called only a few hours until they were going to  cardiovert 
> him out of flutter.  Of course, I immediately stopped  that.  The differential 
> diagnosis, of course, could be tumor.  I plan  to get a gated cardiac MRA to 
> further elucidate the nature of the mass.  I  might consider a transjugular 
> biopsy. If possible, I think the  clot needs to be removed and a maze carried out. 
>  However, I'm unsure  how to handle the perioperative anticoagulation.  HELP!!
> Hal
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