INTRA-CARDIAC THROMBUS IN BEHCETS DISEASE: TWO CASE REPORTS

Behcets disease (BD) is a multi-systemic inflammatory disorder characterized by a recurrent oral and genital aphthosis associated with multiple organ disorders: ophthalmic, neurological, vascular, and digestive.Cardiac involvement in BD especially Intra-cardiac thrombus (ICT) is extremely rare only 50 cases have been registered worldwide [1-5]. We report a rare case of two patients aged respectively 18-year-old and 50-year-old who are diagnosed with Behcets disease complicated by right-sided heart thrombi extended to the pulmonary artery.

FIP1L1-PDGFRA-Associated Hypereosinophilic Syndrome as a Treatable Cause of Watershed Infarction

Background and Purpose: Ischemic stroke has been reported in various conditions associated with eosinophilia. FIP1L1-PDGFRA fusion ([Fip1-like 1-platelet-derived growth factor receptor alpha]; F/P ) leads to the proliferation of the eosinophilic lineage and thus to a clonal hypereosinophilic syndrome that is highly responsive to imatinib. Methods: We previously reported on a nationwide retrospective study of 151 patients with F/P -associated clonal hypereosinophilic syndrome. Patients from this cohort with a clinical history of ischemic stroke (as well as 2 additional cases) were further analyzed to better define their clinical picture and outcomes. Results: Sixteen male patients (median age, 51 [43–59] years) with low-to-intermediate cardiovascular risk were included. Median National Institutes of Health Stroke Scale was 4 (range, 1–6). Most cerebral imaging disclosed multiple bilateral infarctions of watershed distribution (69%). Despite frequent cardiac involvement (50%), cardiac thrombus was evidenced in a single patient and, according to the TOAST classification (Trial of ORG 10172 in Acute Stroke Treatment), 62.5% of strokes were presumably of undetermined etiology. Among the 15 patients treated with imatinib, and after a median follow-up of 4.5 years, stroke recurred in only 3 patients (consisting of either cardio embolic or hemorrhagic events, unrelated to the first episode). Conclusions: F/P + clonal hypereosinophilic syndrome is a diagnosis to consider in patients with unexplained ischemic stroke and hypereosinophilia (especially in the setting of multiple cortical borderzone distribution) and warrants prompt initiation of imatinib.

Echocardiographic Characteristics of Cardiac thrombus in Patients With Mycoplasma pneumoniae infection

Right ventricular thrombus in Mycoplasma pneumoniae pneumonia (MPP) patient is rare. Herein we reported 4 cases of right ventricular thrombus. All of them were diagnosed of severe mycoplasma pneumonia, with increased D-dimer. There was no abnormality in the atrial and ventricular diameters with a normal cardiac function during the course of the illness. Every thrombus was closely attached to the tricuspid chordae. Except one thrombus surgically removed, the remaining thrombi dissolved during the follow-ups.

Evaluation of Cardiac Thrombus Stability based on Contrast-Enhanced Echocardiography：Research Protocol and Preliminary Results

Objective: This study attempted to test a new scoring system for evaluating the stability of cardiac thrombi using contrast-enhanced ultrasound (CEUS). Methods: We used human whole blood to make the thrombus model in vitro which were divided into 2 groups, the 1-hour (T1h) and 7-day (T7d) group. The T1h group was monitored for 1 hour continuously to observe for the formation of a new thrombus on the original thrombus base. Over time, changes in CEUS images and pathology and shear wave elastography (SWE) of thrombus were observed in theT1h and T7 groups. Twenty-eight adult patients diagnosed with a cardiac thrombus were selected and examined by transthoracic echocardiography (TTE) and CEUS. Thrombi were scored for substrate (Ts) and hardness (Th) based on the visualized degree of contrast penetration into the thrombus. The Ts and Th were statistically analyzed for thrombolytic time and the risk of embolism to other organs. Results: In vitro, pathology revealed a decreased pore structure; further, the average Young’s modulus of the thrombi over time indicated a progressive increase in hardness. Contrast-enhancing agents were able to enter a fresh, loose thrombus, but were not able to enter a chronic, stable thrombus. With increasing Ts and Th, thrombolytic time was prolonged, and the risk of embolism to other organs was increased. Conclusions: Our study results suggest that this new CEUS scoring system can evaluate the hardness of a cardiac thrombus and the quality of its underlying substrate; this allows for quantitative evaluation of thrombus stability.