Therapeutic anticoagulation led to the resolution of a large left ventricular mass in a patient with cocaine-induced cardiomyopathy, avoiding a planned thoracotomy.
Case Report (n=1)
This case highlights the importance of considering intracardiac thrombus in patients with left ventricular dysfunction and cocaine use, even with a history of malignancy, as medical management with anticoagulation can resolve the mass and avoid unnecessary surgery.
Background Intracardiac thrombus is a common intracardiac mass in patients with left ventricular dysfunction (LVD). Case Summary A man with a history of malignant melanoma presented with emesis and acute left flank pain. He was found to have a left renal infarct and left ventricle (LV) mass, for which he was started on therapeutic anticoagulation. TTE showed a large, mobile mass measuring 2.5 × 2.0 cm in the LV cavity, with LVD. Cardiac metastasis was suspected, and surgical intervention was planned, but preoperative TEE could not reveal the LV mass seen previously, canceling the planned thoracotomy. Discussion He had patent coronary arteries; therefore, cardiomyopathy was likely due to cocaine use, which might induce thrombosis within the dysfunctional LV. Medical management with therapeutic anticoagulation, along with guideline‐directed medical therapy for LVD, continued.
Shrestha et al. (Thu,) conducted a case report in Left ventricular mass and left ventricular dysfunction (n=1). Therapeutic anticoagulation was evaluated on Resolution of left ventricular mass. Therapeutic anticoagulation led to the resolution of a large left ventricular mass in a patient with cocaine-induced cardiomyopathy, avoiding a planned thoracotomy.