An Interesting Case of Acute Myeloid Leukaemia Presented with Cerebrovascular Embolism and Native Aortic Valve Thrombus Developed Under NOAC Treatment for Pulmonary Embolism

Abstract

Acute myeloid leukemia (AML) can manifest with different signs and symptoms. Acute pulmonary embolism and cranial vascular events are some of these manifestations. However, development of valvular thrombus in the patients without inheritable thrombophilia is extremely rare. Here, we presented a very rare case of AML manifested with multiple cerebrovascular embolisms and a large, mobile native aortic valve thrombus developed under apixaban treatment for unprovoked pulmonary embolism.

Keywords

• Echocardiography
• Leukemia
• Pulmonary Embolism
• Aortic Valve Thrombus

Pulmoner Emboli için Verilen NOAK Tedavisi Altında Gelişen Doğal Aort Kapak Trombüsü ve Serebrovasküler Emboli ile Başvuran İlginç Akut Miyeloid Lösemi Olgusu

Abstract

Akut miyeloid lösemi (AML) değişik bulgu ve belirtiler ile başvurabilir. Akut pulmoner emboli ve kraniyal vasküler olaylar bu başvuru şekillerinden bazılarıdır. Ancak, kalıtsal trombofili olmaksızın hastalarda kapak trombüsü gelişmesi nadirdir. Burada, nedensiz pulmoner emboli için apiksaban tedavisi altındayken çoklu serebrovasküler emboli ve büyük, hareketli aortik kapak trombüsü ile belirti veren çok nadir bir AML olgusu sunduk

Keywords

• Ekokardiyografi
• Lösemi
• Pulmoner Emboli
• Aort Kapak Trombüsü

References

1. 1. Chavez MA, Heidari B, Thacker S, et al. Acute Promyelocytic Leukemia Presenting as Bilateral Acute Limb Ischemia and ST Elevation Myocardial Infarction: A Case Report. Cureus. 2020;12:e8495.
2. 2. Haider AS, Sumdani H, McCaslin J, et al. Aggressive Endovascular Management of Massive Dural Venous Sinus Thrombosis in the Setting of Acute Myeloid Leukemia. Cureus. 2019;11:e3891.
3. 3. Rashidi A, Silverberg ML, Conkling PR, et al. Thrombosis in acute promyelocytic leukemia. Thromb Res. 2013;131:281-289.
4. 4. Sorà F, Chiusolo P, Laurenti L, et al. Massive Pulmonary Embolism at the Onset of Acute Promyelocytic Leukemia. Mediterr J Hematol Infect Dis. 2016;8:e2016027. 5. Hull RD, Hirsh J, Carter CJ, et al. Pulmonary angiography, ventilation lung scanning, and venography for clinically suspected pulmonary embolismwith abnormal perfusion lung scan. Ann Intern Med. 1983;98:891-899.
5. 6. Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41:543-603.
6. 7. Chang H, Kuo MC, Shih LY, et al. Acute promyelocytic leukemia-associated thrombosis. Acta Haematol. 2013;130:1-6.
7. 8. Mangal AK. Cerebrovascular accident due to embolism of a leukemic thrombus. Can Med Assoc J. 1984;131:428.
8. 9. De Martino A, Falcetta G, Colli A. Early Valve Thrombosis in Surgical Aortic Bioprosthesis: Rare or Underestimated Event? J Am Coll Cardiol. 2020;76:1812.

9. 10. Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017;38:2739-2791.
10. 11. Jones CB, Draughn T, Nomeir AM. Aortic valve thrombus presenting as a non- ST elevation myocardial infarction. J Am Soc Echocardiogr. 2008;21:876.e1- 3.
11. 12. Vermeersch G, Prihadi E, De Keulenaer G, et al. Giant native aortic valve thrombus under non-vitamin K antagonist oral anticoagulant: first manifestation of antiphospholipid syndrome. Eur Heart J. 2021;42:1927.