Distinguishing Aortic Valve Thrombus From Libman–Sacks Endocarditis in Antiphospholipid Syndrome: Imaging and Management

Abstract

Aortic valve (AV) thrombus, a rare complication of antiphospholipid syndrome (APLS), is important to distinguish from Libman–Sacks endocarditis because of its responsiveness to anticoagulation. This may be attributed to immunopathologic differences underpinning their development. We present the case of a 45-year-old woman with high-risk primary APLS who developed an AV mass and was taken for valvular repair surgery but found to have pure thrombus and normal valve leaflets. In such cases, a trial of conservative management with anticoagulation may be adequate. Echocardiography, computed tomography and MRI findings suggestive of thrombus without endocarditis are presented. A literature review of histopathologic, imaging and treatment implications of pure AV thrombus in the context of APLS is included.

Keywords:

• anticoagulation
• antiphospholipid syndrome
• aortic valve thrombus
• cardiac MRI
• Libman–Sacks endocarditis

Author contributions

N Premyodhin contributed in the conceptualization, investigation, formal analysis, project administration and roles/writing – original draft preparation. D Glovaci contributed in the conceptualization, investigation, formal analysis and roles/writing – review and editing. S Azam contributed in the formal analysis and roles/writing – review and editing. R Chou contributed in the visualization and roles/writing – review and editing. A Barseghian contributed in the conceptualization, investigation, supervision and roles/writing – review and editing.

Informed consent disclosure

The authors state that they have obtained verbal and written informed consent from the patient/patients for the inclusion of their medical and treatment history within this case report.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.