Antiphospholipid syndrome and right atrial mass

Abstract

Clinical Summary A 43-year-old woman was urgently admitted to the hospital because of a syncopal episode. In the past she had had repeated spontaneous abortions, venous thrombotic events during pregnancy, and thrombocytopenia associated with lupus anticoagulant positivity. A diagnosis of antiphospholipid syndrome (APS) had been suggested 14 years earlier. Results of cardiac physical examination and a 12-lead electrocardiogram were unremarkable. Two-dimensional transthoracic and transesophageal echocardiography showed ventricular and left atrial chambers normal in size and function, whereas a polypus, mobile mass attached to the free wall was visualized in the right atrium (Figure 1, A and B ). Semilunar and atrioventricular valves were normal, without any evidence of vegetations. The patient underwent surgical removal of the mass, and pathologic examination ruled out a neoplastic or infective nature, by showing a fibrin network entrapping blood cells with calcific deposits at its implantation base (Figure 2). The histologic features were in keeping with an organized thrombosis, and a diagnosis of nonbacterial thrombotic endocarditis of the right atrial endocardium in the setting of APS was suggested. At 6 months’ follow-up, the patient is doing well with long-term anticoagulant therapy. She has no evidence of intracardiac mass recurrence on 2-dimensional echocardiography (Figure 1, C ). From the Institutes of Pathological Anatomy, Cardiovascular Surgery, and Rheumatology, University of Padua Medical School, Padua, Italy.