Abstract
Abstract
Background
IVC hyperechoic structure detected by echocardiography is relatively uncommon and is usually associated with deep vein thrombosis and cancers. In most cases, the etiology can be clarified using computed tomography (CT) and magnetic resonance imaging (MRI). However, we encountered an IVC hyperechoic structure that was not confirmed by multimodality imaging in a patient with cardiac myxoma.
Case presentation
A 62-year-old woman presented with sudden-onset left hemiplegia and right homonymous hemianopsia. On arrival, her left arm was cold to the touch. Contrast-enhanced CT demonstrated a left atrial mass, left subclavian artery occlusion, and splenic infarction. Brain MRI revealed an acute infarction in the right occipital lobe. Transthoracic echocardiography (TTE) showed a mobile mass in the left atrium and a 33 mm immobile linear hyperechoic structure with surrounding blood flow in the suprarenal IVC, suggestive of organized thrombus. However, laboratory tests showed no elevation of D-dimer, and cardiac MRI did not confirm any IVC lesion. During surgical planning, there was concern that IVC cannulation via the right atrium for CPB might dislodge a potential thrombus and cause pulmonary embolism. Preoperative transesophageal echocardiography under general anesthesia demonstrated no IVC hyperechoic structure. An IVC cannula was inserted via the right femoral vein under fluoroscopic guidance. Following cardiac arrest and right atriotomy, direct inspection revealed no thrombus or other abnormal structure within the suprarenal IVC. The left atrial tumor was excised via left atriotomy. Histopathological examination confirmed cardiac myxoma. Postoperative TTE showed complete disappearance of the IVC hyperechoic structure.
Conclusions
We report a rare case of IVC hyperechoic structure mimicking a true thrombus in a patient with cardiac myxoma. This phenomenon may be related with spontaneous echo contrast and echocardiographic artifacts. Our case highlights an important diagnostic pitfall in echocardiographic assessment of the IVC and emphasizes the importance of integrating findings from multiple imaging modalities.