Echocardiographic Characteristics of Cardiac thrombus in Patients With Mycoplasma pneumoniae infection
Sun Yan1, Zhang Ning2, Yang Jiao1, Liu Guowen1,Li Jingya1, Zhang Hongju1, Xue Li1, Xu Liyuan1, Ma Ning1*
1 Department of Ultrasound,Beijing Children’s Hospital, Capital Medical University,National Center for children’s Health;2 Emergency General Hospital
Corresponding author: Ma Ning Institute: Department of Ultrasound,Beijing Children’s Hospital, Capital Medical University,National Center for children’s Health
Address: No. 56 Nan Lishi Road, Xicheng District, Beijing 100027, People’s Republic of China.
Tel 008615110236678
E-mail Maning_echo@163.com
Abstract
Right ventricular thrombus in Mycoplasma pneumoniae pneumonia (MPP) patient is rare. Herein we reported 5 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.
key words: Mycoplasma pneumoniae pneumonia, echocardiography, ventricular thrombus
INTRODUCTION
Mycoplasma pneumoniae (MP) is a common pathogen of community-acquired pneumonia (CAP) in children[1]. In recent years, the incidence rate of Mycoplasma pneumoniae pneumonia (MPP) has been increasing, suggesting an epidemic trend.
Severe cases and those cases refractory to treatments have increased[2,3]. In addition to pulmonary inflammation, some children with refractory MPP may have two or more non- pulmonary complications. In recent years, MPP complications with lower extremity thrombosis have been reported[4]. There is only three cases of right ventricular thrombosis reported in literature [5-6]. Our current study reports 5 cases of severe mycoplasma pneumonia complicated with right ventricular thrombosis diagnosed in our hospital. It further analyzes the characteristics of echocardiography in detail. We hope this report will be helpful in the future recognition and diagnosis of right ventricular thrombus in MMP.
CASE PRESENTATIONS: All these cases were male, age of 6-9 years, hospitalized in our hospital from January 2016 to December 2019. Their initial diagnoses were mycoplasma pneumonia, later developed a complication of right ventricular thrombosis. Their initial symptom was fever, 39.5-40.5℃, with dry cough. Three of the 5 cases were found locally to have right ventricular space occupying lesions and came to our hospital for further diagnosis and treatment. In the remaining 2 cases, the ventricular space occupying lesions were first found during hospitalization in our hospital. The patients provided informed consent for the publication of this report.
The general information of all patients is shown in Table 1. Their serum cold agglutination test results were elevated to ≥ 1:320. D-dimer was significantly elevated, 4.03-9.06 mg/L (normal 0-0.24 mg/L). Chest CTs showed variable degrees of pulmonary infiltration and pleural effusion. All the cardiac space occupying lesions were first detected by echocardiography. (Figure 1-4) (video 1-2)
Table 1 general date of each case