Intracardiac thrombus in an adult patient with nephrotic syndrome

Abstract

Key words: left atrial thrombus; membranous glom-erulonephritis; nephrotic syndromeIntroductionThromboembolic phenomena including renal veinthrombosis remai onn e of th mose t serious complica-tions of patients with nephrotic syndrome. Althoughthe literatur one th changee osf th varioue s bloodcoagulation and fibrinolysis factors seems to be confus-ing, the well-documented increased incidenc of throme -botic event ins nephrotic patients woul a d suggestcausal relationship In al adul.l t serie of nephroticss ,venous thrombosis and pulmonary embolism are muchmore common than arterial thrombosis has , whichbeen mainly reporte in childrend . Intraeardiae throm-bus is among the rarest arterial thromboses reportedin the literature. Six paediatric patients with intraeard-iae thrombi have been reporte twd includino fro m gEgli's series [1]. We repor at n adult with membranousglomerulonephritis with nephrotic syndrome complic-ated by left atrial appendage thrombu to s leadingperipheral arterial embolis anmd limb loss. Resolutionof the atrial thrombu was s documented after remissionof the nephrotic syndrom ane d anticoagulation.Case ReportA 65-year-old woman was admitted to our unit becauseof bilateral ankle fo swellinr 1 days0g Sh. e had nohistory o intermittenf t claudication or rena l, heartdiseases, nor an history oyf venereal exposure The .family histor way alss o unremarkabl and she e hadstopped smokin 4 yearg agos . O admissionn , apartfrom bilateral ankle oedema, physical examinatio was nnormal. He bloor d pressur wa 120/8se 0 mmH angdexamination of th peripherae l pulse and cardiovass -cular system was unremarkable He. r haemoglobin was12 g/dl an haematocrid 36%t . She heav had proy -teinuria (11.86 g/24 h), hyaline i castn urines an, d a