Chronic disseminated intravascular coagulation induced by left atrial thrombus in a patient with giant "normal" heart: A case report

Abstract

Introduction: We herein describe a patient with chronic disseminated intravascular coagulation (DIC) induced by a giant thrombus in the left atrium.A 63-year-old woman was admitted to our hospital for evaluation of extensive mucocutaneous hemorrhage, especially at the sites of venipuncture, on May 21, 2015. Considering her long history of rheumatic heart disease and atrial fibrillation and her mitral valve replacement performed several years previously, we strongly suspected that the bleeding was closely related to postoperative over-anticoagulation of warfarin. After careful investigation, we found that her coagulopathy was induced by the chronic DIC, which was in turn secondary to a left atrial giant thrombus. This is a rarely reported cause of chronic DIC. Cardiac computed tomography and echocardiography showed apparent biatrial enlargement; the morphology and function of the ventricles were unaffected. After anticoagulant therapy, the bleeding tendency and coagulation index were significantly improved.

Conclusion: A left atrial thrombus should be considered as a differential diagnosis of chronic DIC, especially in patients with predisposing heart conditions. Because treatment of the underlying cause is paramount in the management of chronic DIC, this case is of great clinical value.

Figure 1

Extensive mucocutaneous hemorrhage upon admission. (A) Hemorrhage on the dorsum of the left foot on admission. (B) Hemorrhage on the dorsum of the left foot after treatment. (C) Hemorrhage on the left arm on admission. (D) Hemorrhage on the left ankle on admission. (E) Hemorrhage on the left ankle after treatment. (F) Hemorrhage on the dorsum of the left hand.

Figure 2

Echocardiography findings upon admission. (A) Giant left atrium (144 × 120 mm). (B) Giant thrombus within left atrium (28.9 × 67.1 mm).

Figure 3

Cardiac computed tomography findings during hospital stay. (A) Cortical reconstruction and (B) volume rendering technique showed the maximum diameter of the giant heart. The fine arrow indicates the replaced metal mitral valve; the bold arrow indicates the giant thrombus in the left atrium. (C) This picture shows the giant heart of our patient. The fine arrow indicates the replaced metal mitral valve. (D) This picture shows the giant thrombus in the left atrium (bold arrow).