[HSF] Antiphospholipid Syndrome

[Nasser F. Abou'Seada]

Dear Claudia 

That was very kind of you indeed

Thank you very much 

 

NFA

-----Original Message-----
From: claudia miranda [mailto:cvteles at gmail.com] 
Sent: Wednesday, January 17, 2007 3:55 PM
To: Hgrmd at aol.com; prasannasimha; Nasser F. Abou'Seada
Subject: Re: [HSF] Antiphospholipid Syndrome

 


Here it is.

 

Hope it helps.

 

Claudia
 

2007/1/16, Hgrmd at aol.com <Hgrmd at aol.com>: 

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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