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A 52 Age - year Age - old Age man Sex ( body History surface History area: History 1.3 History m2 History ) known to have dilated Disease_disorder cardiomyopathy Disease_disorder ( DCM Disease_disorder ), was admitted Clinical_event for worsening heart Disease_disorder failure Disease_disorder ( NYHA Lab_value class Lab_value IV Lab_value ).
He presented with a 5 Duration - month Duration history of cough Sign_symptom , progressive Detailed_description dyspnoea Sign_symptom , orthopnea Sign_symptom and recurrent Detailed_description upper Biological_structure abdominal Biological_structure pain Sign_symptom started from Duration 2 Duration months Duration ago Duration .
On examination Diagnostic_procedure his vital Diagnostic_procedure signs Diagnostic_procedure were body Diagnostic_procedure temperature Diagnostic_procedure 37°C Lab_value , blood Diagnostic_procedure pressure Diagnostic_procedure 80/40 Lab_value mmHg Lab_value , respiratory Diagnostic_procedure rate Diagnostic_procedure 24 Lab_value breaths Lab_value per Lab_value minute Lab_value , and electrocardiogram Diagnostic_procedure showed atrial Disease_disorder fibrillation Disease_disorder with heart Diagnostic_procedure rate Diagnostic_procedure 50 Lab_value beats Lab_value per Lab_value minute Lab_value .
Physical Diagnostic_procedure examination Diagnostic_procedure revealed the jugular Biological_structure venous Biological_structure distension Sign_symptom , significant Severity tender Detailed_description hepatomegaly Sign_symptom and bilateral Detailed_description pitting Detailed_description edema Sign_symptom at lower Biological_structure limbs Biological_structure .
Laboratory Diagnostic_procedure tests Diagnostic_procedure showed elevated Lab_value pro Diagnostic_procedure - NT Diagnostic_procedure brain Diagnostic_procedure natriuretic Diagnostic_procedure peptide Diagnostic_procedure of 22145 Lab_value pg/ml Lab_value (normal 0 to 227 pg/ml) and unremarkable Lab_value D Diagnostic_procedure - dimer Diagnostic_procedure .
X Diagnostic_procedure - ray Diagnostic_procedure and computed Diagnostic_procedure tomography Diagnostic_procedure of the chest Biological_structure demonstrated consolidation Sign_symptom of bilateral Biological_structure lower Biological_structure lobes Biological_structure with pleural Sign_symptom effusion Sign_symptom , while his venous Biological_structure Doppler Diagnostic_procedure of lower Biological_structure extremities Biological_structure was normal Lab_value .
Based on his clinical condition, echocardiography Diagnostic_procedure was immediately inserted.
There were severe Severity dilated Sign_symptom cardiac Sign_symptom chambers Sign_symptom , especially enlargement Sign_symptom of the left Biological_structure ventricle Biological_structure ( LV Biological_structure ) ( 58 Lab_value mm/m2 Lab_value ) with spherical Sign_symptom shape Sign_symptom , decreased Sign_symptom wall Sign_symptom thickness Sign_symptom , impaired Lab_value ejection Diagnostic_procedure fraction Diagnostic_procedure 22% Lab_value and severe Severity mitral Sign_symptom regurgitation Sign_symptom on two Diagnostic_procedure - dimensional Diagnostic_procedure transthoracic Diagnostic_procedure echocardiography Diagnostic_procedure ( 2DTTE Diagnostic_procedure ).
Parasternal short axis and subxyphoid view (Figure ​1) showed the mobile Detailed_description right Biological_structure atrial Biological_structure mass Sign_symptom highly suspicious of a thrombus Disease_disorder traversing the right Biological_structure atrial Biological_structure cavity Biological_structure during the cardiac cycle accompanying with free Detailed_description - floating Detailed_description small Detailed_description parts Detailed_description of the thrombi Disease_disorder .
Real Diagnostic_procedure - time Diagnostic_procedure three Diagnostic_procedure dimensional Diagnostic_procedure transthoracic Diagnostic_procedure echocardiography Diagnostic_procedure (RT-3DTTE) was performed to further confirm the nature of mass Sign_symptom .
It Coreference showed a highly Detailed_description mobile Detailed_description thrombus Disease_disorder , irregular Shape in Shape contour Shape , measured 2.6 Area × Area 1.0 Area cm Area which floating around the orifice Biological_structure of Biological_structure inferior Biological_structure vena Biological_structure cava Biological_structure and protruding Biological_structure into Biological_structure the Biological_structure right Biological_structure atrial Biological_structure cavity Biological_structure (Figure ​2).
In addition, RT-3DTTE evaluated right Biological_structure ventricle Biological_structure ( RV Biological_structure ) systolic Sign_symptom dysfunction Sign_symptom with ejection Diagnostic_procedure fraction Diagnostic_procedure 15.7% Lab_value (Figure ​3).
He was maintained on digoxin Medication , spironolactone Medication , furosemide Medication , sotalol Medication and dopamine Medication .
At the same time therapeutic Therapeutic_procedure anticoagulation Therapeutic_procedure was started with low Detailed_description - molecular Detailed_description - weight Detailed_description heparin Medication and warfarin Medication .
The patient had an uneventful Lab_value hospital Therapeutic_procedure course Therapeutic_procedure and one Date week Date follow Clinical_event - up Clinical_event echocardiography Diagnostic_procedure confirmed adequate removal of the thrombus Disease_disorder (Figures 4A and ​4B).