Czternastoletni chłopiec z podejrzeniem guza prawego przedsionka – znaczenie wywiadu rodzinnego w diagnostyce różnicowej

Piotr Wieniawski¹, Wioletta Guzik², Michał Brzewski³, *Bożena Werner¹

Summary
Fourteen-year-old boy, feeling healthy so far, was admitted to the hospital with effort intolerance and symptoms such as chest pain, cough and fever. X-ray examination revealed pneumonia and on transthoracic echocardiography pedunculated structure in the right atrium was found. The patient was admitted to the Department of Cardiology in a good general condition, without any significant abnormalities in physical examination. He reported retrosternal pain, which gradually intensified during the day of admission. Tachypnea and tachycardia were observed. On physical examination respiratory sounds at the base of the lungs on both sides were diminished. Laboratory tests showed positive markers of inflammation, negative exponents of myocardium damage, elevated levels of D-dimers (4-fold) (no other abnormalities of coagulation parameters). Angio-CT was performed which confirmed suspected pulmonary embolism. Under the urgency procedure, thrombus from the right atrium was surgically removed and pulmonary embolectomy aspiration was performed. Patient was finally diagnosed with family deficiency of S protein.

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