RESUMEN

RATIONALE: Alcoholic cardiomyopathy (ACM) is associated with various cardiac complications, but the development of isolated right atrial (RA) thrombus without deep vein thrombosis is rare and presents diagnostic challenges. PATIENT CONCERNS: A 53-year-old Hispanic male presented with shortness of breath, chills, cough, bilateral lower extremity edema, and distended abdomen. DIAGNOSES: The patient was diagnosed with ACM, liver cirrhosis, and a large RA thrombus. Initial transthoracic echocardiography showed severe left ventricular systolic dysfunction but failed to detect the RA mass. Subsequent computed tomography scan and transesophageal echocardiography revealed a large oval mass in the RA, measuring 40 mm × 22 mm × 18 mm. INTERVENTIONS: The patient received guideline-directed medical therapy for heart failure and anticoagulation with enoxaparin. He underwent cardiac catheterization for mechanical thrombectomy, which was minimally successful. OUTCOMES: The patient's condition was managed with the prescribed interventions. Regular follow-up was planned to assess thrombolysis. LESSONS: RA thrombosis is an uncommon complication of ACM. A multimodal imaging approach, with a low threshold for transesophageal echocardiography, is crucial in evaluating patients with ACM who present with cardiac complications. This approach enables accurate diagnosis and management of rare conditions like isolated RA thrombosis.

Asunto(s)

Cardiomiopatía Alcohólica , Atrios Cardíacos , Trombosis , Humanos , Masculino , Persona de Mediana Edad , Trombosis/etiología , Trombosis/diagnóstico por imagen , Atrios Cardíacos/diagnóstico por imagen , Cardiomiopatía Alcohólica/complicaciones , Cardiomiopatía Alcohólica/diagnóstico , Ecocardiografía Transesofágica/métodos , Cardiopatías/etiología , Cardiopatías/diagnóstico , Cateterismo Cardíaco/métodos , Trombectomía/métodos

RESUMEN

INTRODUCTION: An Epidural hematoma following a Ventriculoperitoneal shunt is a critically rare complication. Due to that rarity and potential dangers, we present a case where the patient became symptomatic 8 h after shunting requiring craniotomy for evacuation of the hematoma. The literature and treatment options were discussed. CASE PRESENTATION: A 40-year-old male arrived to the emergency department in a comatose state with dilated pupils, 8 h post-ventriculoperitoneal shunt placement. Computed tomography showed a massive hyperacute epidural hematoma causing severe midline deviation and subfalcine herniation, leading to emergency craniotomy. Despite surgical intervention and intensive care, the patient's condition did not improve, resulting in his death. DISCUSSION: Epidural hematomas (EDHs) are an infrequent complication of ventricular drainage procedures, occurring at a documented frequency of 0.4 %, often presenting with symptoms mimicking shunt malfunction or mass lesions. Diagnosis involves computed tomography (CT) scans, but magnetic resonance imaging (MRI) may be more sensitive. Treatment options include conservative management and surgical intervention, with prognosis heavily dependent on the patient's neurological status at the time of surgery, with mortality rates varying based on level of consciousness. CONCLUSION: This study presents a rare case of fatal hyperacute epidural hematoma following Ventriculoperitoneal shunt (VPS) placement in a 40-year-old man, highlighting the importance of early detection and intervention. The hypotheses suggests overloaded pressure on the dura during ventricular end insertion. Despite available treatment options, patient prognosis depends on neurological status at the time of surgery, emphasizing the need for further research into effective management strategies for this complication.