Primary coronary sinus thrombosis with pulmonary embolism in a patient with systemic lupus erythematosus and secondary antiphospholipid syndrome: a case report

Abstract

Primary Intracardiac thrombosis in the absence of indwelling catheters or pacemaker etc. is an uncommon complication.Although cases of primary coronary sinus thrombosis are reported, most cases occur due to endothelial damage following invasive cardiac procedures involving the right atrium, such as Central Venous Pressure (CVP) placement, Right Ventricle (RV) pacing, cardiac resynchornising therapy and cardiac transplant.We report the case of a 31 yr – old woman, who was admitted with chest discomfort and exertional dyspnea and was found by investigation to have Systemic Lupus Erythematosus (SLE) with secondary antiPhospholipid antibody syndrome. Subsequent 64 slice spiral computerised tomography showed pulmonary embolism. In addition, Trans-Thoracic Echocardiography (TTE) and Trans-Esophageal Echocardiography (TEE) revealed an hyperechoic signal highly suggestive of tumor/thrombus at an unusual site, namely the coronary sinus. The patient underwent surgery under cardiopulmonary bypass and moderate hypothermia. The organized calcified tumor/thrombus was removed through trans-atrial approach and an 8mm Polytetrafluoroethylene (PTFE) graft was placed at the coronary sinus opening. Histological examination of the specimen obtained from the coronary sinus showed an organised, partially- calcified thrombus. In our patient, pre-operative investigations could not differentiate a thrombus from a mass and the definitive diagnosis was made post- operatively.