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Left ventricular thrombus in a patient with esophageal carcinoma/Ozofagus karsinomlu bir hastada sol ventrikul icinde trombus.

A 49-year-old, male patient who had been treated with the diagnosis of inoperable esophageal carcinoma (poorly differentiated adenocarcinoma) recently was admitted to our cardiology department. He was suffering from dyspnea, palpitation and chest pain. He had been given radiotherapy, cisplatin and 5- fluorouracil for the cancer therapy previously. His physical examination was normal. Precordial negative T waves and horizontal ST depression were seen on the electrocardiogram. Cardiac enzymes were normal. Echocardiography (Fig. 1 and 2) and cardiac magnetic resonance imaging (Fig. 3 and 4) showed us a fairly mobile, pedunculated masses in the left ventricle (See corresponding video/movie image at www.anakarder.com) without any wall motion abnormalities. The patient underwent surgery because of a transient ischemic attack. Pathological evaluation of the specimen, which was taken during the surgery revealed a thrombus as the origin of the masses.

[FIGURES 1-4 OMITTED]

The 5- fluorouracil has endothelial toxicity resulting in thrombogenic effect and release of vasoactive substances (1, 2). Patients with prior coronary disease and/or those receiving concurrent radiation therapy are at risk for 5- fluorouracil induced heart disease (3). Cisplatin has also potential endothelial and vasospastic effects. There is one case on cisplatin induced localized aortic thrombus and one case about transient intracardiac thrombus after 5-fluorouracil therapy on the literature (4, 5). Cancer also promotes the synthesis and secretion of procoagulants.

References

(1.) Prunier F, Monsegu J, Coutant G, Ollivier JP. Emergency coronary angioplasty following treatment with 5-fluorouracil. Rev Med Interne 2000; 21: 439-44.

(2.) Kinhult S, Albertsson M, Eskilsson J, Cwikiel M. Antithrombotic treatment in protection against thrombogenic effects of 5-fluorouracil on vascular endothelium: a scanning microscopy evaluation. Scanning 2001; 23: 1-8.

(3.) Timour Q, Lombard-Bohas C, Slim R, Barel C, Bui-Xuan B, Tabib A, Bricca G, et al. Cardiotoxicity of 5-fluorouracil: report of 6 cases. Therapie 2002; 57: 302-6.

(4.) Leitman M, Baram S, Sidenko S, Abo-Kishk I, Peleg E, Vered Z. Transient left ventricular and right atrial thrombosis after 5-fluorouracil therapy. J Am Soc Echocardiogr 2004; 17: 778-9.

(5.) Apiyasawat S, Wongpraparut N, Jacobson L, Berkowitz H, Jacobs LE, Kotler MN. Cisplatin induced localized aortic thrombus. Echocardiography 2003; 20: 199-200.

Tolga Ozyigit, Zehra Bugra *

Department of Cardiology, American Hospital, Istanbul * Department of Cardiology, Istanbul Faculty of Medicine, University of Istanbul, Istanbul, Turkey
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Title Annotation:Original Image/Orijinal Goruntu
Author:Ozyigit, Tolga; Bugra, Zehra
Publication:The Anatolian Journal of Cardiology (Anadolu Kardiyoloji Dergisi)
Date:Mar 1, 2007
Words:377
Previous Article:Rare coronary artery anomaly: a single coronary artery arising from the right sinus of Valsalva/Nadir gorulen koroner arter anomalisi: Sag sinus...
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