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A Rare Case of Splenic Infarct Secondary to Mobile Cardiac Echodensity
Lambl’s excrescences (LE) are mobile filiform lesions, mostly found on the left-sided heart valves. Histologically, they have a mesenchymal origin with a single endothelial layer. They have the potential to detach, resulting in catastrophic thromboembolic events. Their rarity often leads to them bei...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Cureus
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10622253/ https://www.ncbi.nlm.nih.gov/pubmed/37927647 http://dx.doi.org/10.7759/cureus.46434 |
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author | Ramanan, Sruthi Singh, Harjinder Ahmed, Omair Zande, Mark Trimble, Malcom |
author_facet | Ramanan, Sruthi Singh, Harjinder Ahmed, Omair Zande, Mark Trimble, Malcom |
author_sort | Ramanan, Sruthi |
collection | PubMed |
description | Lambl’s excrescences (LE) are mobile filiform lesions, mostly found on the left-sided heart valves. Histologically, they have a mesenchymal origin with a single endothelial layer. They have the potential to detach, resulting in catastrophic thromboembolic events. Their rarity often leads to them being misdiagnosed as vegetations of endocarditis with patients failing to improve on conventional therapy. A 48-year-old female with a history of hypertension presented to the Emergency Department with a one-week history of sharp left upper quadrant pain. She was vitally stable; the only lab abnormality was revealed to be a mildly elevated white cell count. CT abdomen revealed a splenic infarct involving 25% of the parenchyma. Patients had no history of abdominal trauma, coagulation disorders, exogenous estrogen use or IV drug abuse. Subsequent investigations failed to reveal any cause of hypercoagulability. An extensive cardiac workup revealed no arrhythmias, but transesophageal echocardiogram showed a mobile echo density on the ventricular side of the aortic valve attached at the coaptation zone, approximately 2.7 cm long and 0.1 cm wide, suggesting a very prominent Lambl’s excrescence. In the absence of any other findings, the patient’s splenic infarct was determined to be secondary to an embolic event from the aortic valve lesion. Rivaroxaban was initiated and the patient subsequently improved. Existing literature describes most LEs as being asymptomatic and discovered incidentally on echocardiograms. This case illustrates the need to develop a criterion for prompt identification of LEs and differentiating them from the vegetations of endocarditis. It also brings forth the question of prophylactic treatment of these lesions while highlighting the lack of guidelines regarding the management of embolic phenomena secondary to LE. |
format | Online Article Text |
id | pubmed-10622253 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Cureus |
record_format | MEDLINE/PubMed |
spelling | pubmed-106222532023-11-04 A Rare Case of Splenic Infarct Secondary to Mobile Cardiac Echodensity Ramanan, Sruthi Singh, Harjinder Ahmed, Omair Zande, Mark Trimble, Malcom Cureus Internal Medicine Lambl’s excrescences (LE) are mobile filiform lesions, mostly found on the left-sided heart valves. Histologically, they have a mesenchymal origin with a single endothelial layer. They have the potential to detach, resulting in catastrophic thromboembolic events. Their rarity often leads to them being misdiagnosed as vegetations of endocarditis with patients failing to improve on conventional therapy. A 48-year-old female with a history of hypertension presented to the Emergency Department with a one-week history of sharp left upper quadrant pain. She was vitally stable; the only lab abnormality was revealed to be a mildly elevated white cell count. CT abdomen revealed a splenic infarct involving 25% of the parenchyma. Patients had no history of abdominal trauma, coagulation disorders, exogenous estrogen use or IV drug abuse. Subsequent investigations failed to reveal any cause of hypercoagulability. An extensive cardiac workup revealed no arrhythmias, but transesophageal echocardiogram showed a mobile echo density on the ventricular side of the aortic valve attached at the coaptation zone, approximately 2.7 cm long and 0.1 cm wide, suggesting a very prominent Lambl’s excrescence. In the absence of any other findings, the patient’s splenic infarct was determined to be secondary to an embolic event from the aortic valve lesion. Rivaroxaban was initiated and the patient subsequently improved. Existing literature describes most LEs as being asymptomatic and discovered incidentally on echocardiograms. This case illustrates the need to develop a criterion for prompt identification of LEs and differentiating them from the vegetations of endocarditis. It also brings forth the question of prophylactic treatment of these lesions while highlighting the lack of guidelines regarding the management of embolic phenomena secondary to LE. Cureus 2023-10-03 /pmc/articles/PMC10622253/ /pubmed/37927647 http://dx.doi.org/10.7759/cureus.46434 Text en Copyright © 2023, Ramanan et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Internal Medicine Ramanan, Sruthi Singh, Harjinder Ahmed, Omair Zande, Mark Trimble, Malcom A Rare Case of Splenic Infarct Secondary to Mobile Cardiac Echodensity |
title | A Rare Case of Splenic Infarct Secondary to Mobile Cardiac Echodensity |
title_full | A Rare Case of Splenic Infarct Secondary to Mobile Cardiac Echodensity |
title_fullStr | A Rare Case of Splenic Infarct Secondary to Mobile Cardiac Echodensity |
title_full_unstemmed | A Rare Case of Splenic Infarct Secondary to Mobile Cardiac Echodensity |
title_short | A Rare Case of Splenic Infarct Secondary to Mobile Cardiac Echodensity |
title_sort | rare case of splenic infarct secondary to mobile cardiac echodensity |
topic | Internal Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10622253/ https://www.ncbi.nlm.nih.gov/pubmed/37927647 http://dx.doi.org/10.7759/cureus.46434 |
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