# Intracardiac thrombus discovered incidentally during respiratory distress in an 18-month-old infant: case report

## TL;DR

An 18-month-old child with no prior health issues had a large heart clot discovered during a respiratory emergency, which was successfully treated with medication.

## Contribution

This case report presents a rare pediatric instance of a giant intracardiac thrombus managed medically without surgery.

## Key findings

- The thrombus was attributed to deficiencies in proteins C and S, indicating a hypercoagulable state.
- Medical treatment with dobutamine, furosemide, and heparin led to complete resolution of the thrombus within 15 days.
- The case suggests that non-surgical management can be effective for pediatric intracardiac thrombi.

## Abstract

Intracardiac thrombi (ICT) are uncommon in the pediatric population and can lead to significant morbidity and mortality. This case highlights a unique instance of a giant ICT in an 18-month-old infant with no notable medical history, contributing to the understanding of hypercoagulable states and their implications in pediatric patients. The patient presented with respiratory distress, characterized by a flu-like syndrome, cyanosis, and hypoxemia. Initial examination revealed lethargy and significant respiratory distress, with imaging showing lobar pneumonia and an echocardiogram revealing a 32 mm x22 mm heterogeneous mass in the left ventricle. Further investigations confirmed the mass was a thrombus, attributed to deficiencies in proteins C and S. The patient was treated with dobutamine to enhance contractility, furosemide for diuresis, and heparin for anticoagulation. There was a favorable progression, with gradual weaning from oxygen and complete resolution of the thrombus by day 15. This case underscores the importance of recognizing hypercoagulable states in pediatric patients with ICT. It suggests that medical management can be an effective alternative to surgical interventions. Moreover, it emphasizes the need for further research to establish optimal treatment protocols for pediatric ICT, particularly regarding the risks associated with thrombus size and ventricular function.