Klinicist (Jul 2017)
MASS IN THE RIGHT ATRIUM IMITATING A TUMOR IN BEHCET’S DISEASE
Abstract
The objective is to describe a rare clinical case of Behcet’s disease with right atrium thrombosis and suspicion of a heart tumor.Materials and methods. Woman, 34 years old, in December of 2015 sought medical help at a local outpatient facility, and then from a gynecologist at the Central Clinical Hospital of Civil Aviation due to painful ulcers in the genital area and fever. Her state was considered a nonherpetic infection, antiviral therapy was administered. Ulcers in the oral cavity and genital area were first diagnosed in August of 2015. In April of 2016, aphthous stomatitis developed. The patient also complained of oral ulcers, fatigue, body temperature increase up to subfebrile values, slight shortness of breath during physical activity, discomfort in the upper part of the stomach. Ultrasound of the abdominal organs and heart had shown a mass resembling a thrombus in the hepatic vein and inferior vena cava which reached the right atrium. The size of the non-mobile mass in the atrium was 38 × 25 mm. The patient was hospitalized in a cardiological department.The following examinations were performed: standard laboratory tests, electrocardiogram, repeat ultrasound of the abdominal organs and heart, X-ray of the chest, oncocytomarker tests, magnetic resonance imaging (MRI), spiral computed tomography (SCT) with contrast of the pelvic and abdominal organs.Subsequently, due to uncertain diagnosis the patient was consulted at the A.N. Bakoulev Scientific Center for Cardiovascular Surgery, N.N. Blokhin Russian Cancer Research Center, V.A. Nasonova Research Institute of Rheumatology.Results. Ultrasound of the heart and abdominal organs had shown a large mass in the inferior vena cava extending to the right atrium, which lead to a suspicion of a myxoma or thrombosis. After MRI of the heart and abdominal organs, an infectious thrombus in the heart and inferior vena cava was suggested. SCT with contrast of the pelvic and abdominal organs, oncocytomarker tests didn’t show any pathology. The combination of aphtous ulcers of the mouth and genitalia and inferior vena cava thrombosis allowed to suspect the Behcet’s disease. This diagnosis was confirmed at the V.A. Nasonova Research Institute of Rheumatology. Prescribed immunosuppressive therapy (meripred, azathioprine, colchicine), which is still ongoing, led to a decrease in inflammatory activity (С-reactive protein), reduction of the thrombus in the right atrium and inferior vena cava. Currently, the patient continues to receive the prescribed immunosuppressive therapy. No complaints, feeling healthy, working. The patient remains under the care of physicians.Conclusion. This clinical case demonstrates diagnostic complications of detection of masses in the heart which can represent a tumor or a thrombus. In the described case, diagnosis of the Behcet’s disease was facilitated by typical aphtous ulcers of the mucosa of the mouth and genitalia and development of vasculitis with subsequent thrombosis of the inferior vena cava and right atrium.
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