intrcrdic clot

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Basil Okeahialam

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Sep 17, 2023, 12:26:32 AM9/17/23
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Dear  All,
A Nigerian living in The Gambia was seen with an intracardiac clot straddling the tricuspid valve. It failed to lyse with thrombolysis and he was left on Apixaban. His symptoms have remained and he asked to find where he can get help, maybe Surgical since medical treatment has failed. The echo image is attached. Would be glad to get feedback for him
IMG-20230202-WA0010 (1).jpg

Kamilu Karaye

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Sep 17, 2023, 1:45:38 AM9/17/23
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Good morning Sir. Surgjcal treatment is the way to go - it looks more like a tumour than a blood clot to me.

Kind regards,
Kamilu Karaye

On 17 Sep 2023, at 05:26, 'Basil Okeahialam' via NIGERIAN CARDIAC SOCIETY <nigerian-car...@googlegroups.com> wrote:



Dear  All,
A Nigerian living in The Gambia was seen with an intracardiac clot straddling the tricuspid valve. It failed to lyse with thrombolysis and he was left on Apixaban. His symptoms have remained and he asked to find where he can get help, maybe Surgical since medical treatment has failed. The echo image is attached. Would be glad to get feedback for him

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IMG-20230202-WA0010 (1).jpg

nazeer shehu

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Sep 17, 2023, 2:07:17 AM9/17/23
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Good morning sir. Another good differential is right side atrial myxoma , which is amenable to surgery. I humbly suggest as follows:
- To post the short video clip of the echo image if available sir. This will make it clearer for the surgeons and interventionists to decide.
- It can also be posted to our NCS WhatsApp group for rapid and prompt response. 

Thank you sir.
Nazeer 

On Sun, Sep 17, 2023 at 6:45, 'Kamilu Karaye' via NIGERIAN CARDIAC SOCIETY
Good morning Sir. Surgjcal treatment is the way to go - it looks more like a tumour than a blood clot to me.

Kind regards,
Kamilu Karaye

On 17 Sep 2023, at 05:26, 'Basil Okeahialam' via NIGERIAN CARDIAC SOCIETY <nigerian-car...@googlegroups.com> wrote:



Dear  All,
A Nigerian living in The Gambia was seen with an intracardiac clot straddling the tricuspid valve. It failed to lyse with thrombolysis and he was left on Apixaban. His symptoms have remained and he asked to find where he can get help, maybe Surgical since medical treatment has failed. The echo image is attached. Would be glad to get feedback for him

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IMG-20230202-WA0010 (1).jpg

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maclean akpa

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Sep 17, 2023, 3:03:16 AM9/17/23
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Please contact Dr Edafe, he will be able to do endovascular intervention



On Sun, 17 Sep 2023 at 6:45, 'Kamilu Karaye' via NIGERIAN CARDIAC SOCIETY
Good morning Sir. Surgjcal treatment is the way to go - it looks more like a tumour than a blood clot to me.

Kind regards,
Kamilu Karaye

On 17 Sep 2023, at 05:26, 'Basil Okeahialam' via NIGERIAN CARDIAC SOCIETY <nigerian-car...@googlegroups.com> wrote:



Dear  All,
A Nigerian living in The Gambia was seen with an intracardiac clot straddling the tricuspid valve. It failed to lyse with thrombolysis and he was left on Apixaban. His symptoms have remained and he asked to find where he can get help, maybe Surgical since medical treatment has failed. The echo image is attached. Would be glad to get feedback for him

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IMG-20230202-WA0010 (1).jpg

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Sandra Ofori

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Sep 17, 2023, 6:19:50 AM9/17/23
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Dear prof,

Did they do echo with contrast or an MRI to establish this is thrombus and not tumor?

Thanks,
Sandra 

On 17 Sep 2023, at 3:03 am, 'maclean akpa' via NIGERIAN CARDIAC SOCIETY <nigerian-car...@googlegroups.com> wrote:

Please contact Dr Edafe, he will be able to do endovascular intervention
On Sun, 17 Sep 2023 at 6:45, 'Kamilu Karaye' via NIGERIAN CARDIAC SOCIETY
Good morning Sir. Surgjcal treatment is the way to go - it looks more like a tumour than a blood clot to me.

Kind regards,
Kamilu Karaye

On 17 Sep 2023, at 05:26, 'Basil Okeahialam' via NIGERIAN CARDIAC SOCIETY <nigerian-car...@googlegroups.com> wrote:



Dear  All,
A Nigerian living in The Gambia was seen with an intracardiac clot straddling the tricuspid valve. It failed to lyse with thrombolysis and he was left on Apixaban. His symptoms have remained and he asked to find where he can get help, maybe Surgical since medical treatment has failed. The echo image is attached. Would be glad to get feedback for him

--
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To view this discussion on the web visit https://groups.google.com/d/msgid/nigerian-cardiac-society/66178544.1422391.1694924773008%40mail.yahoo.com.

<IMG-20230202-WA0010 (1).jpg>

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.

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<IMG-20230202-WA0010 (1).jpg>

Okechukwu Ogah

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Sep 17, 2023, 6:25:25 AM9/17/23
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Thanks prof. Looks more like a tumour than clot. Needs further evaluation
Thanks sir
Ogah
Dr O.S Ogah. MBBS, MSc, PhD, MD, FWACP, FACP, FESC, FNCS

A. Senior Lecturer
Cardiology Unit, Department of Medicine,
Faculty of Clinical Sciences
College of Medicine,
University of Ibadan, NIGERIA

B. Honorary Consultant Physician/Cardiologist,
Cardiology Unit,
Department of Medicine
University College Hospital Ibadan, NIGERIA

PERSONAL POSTAL ADDRESS
P.O BOX 14343, UNIVERSITY OF IBADAN  POST OFFICE
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Tel. +234 806 77 47 121
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C. Bernard Lown Visiting Scholar in Cardiovascular Health
Department of Global Health and Population
Harvard T.H. Chan School of Public Health

D. Adjunct Researcher,
Institute of Advanced Medical Research and Training (IAMRAT)
College of Medicine, University of Ibadan, NIGERIA

E. Affiliate Member,
The Hatter Institute for Cardiovascular Research in Africa (HICRA)
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collins ugwu

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Sep 17, 2023, 6:26:15 AM9/17/23
to nigerian-car...@googlegroups.com, Sandra Ofori
Good morning Prof, 
I think, it looks more like a tumor than a clot. 
I will suggest surgical intervention. 
Collins Ugwu 

femi thomas

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Sep 17, 2023, 6:46:04 AM9/17/23
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I advise you contact Tristate. It looks like a solid mass.



On Sun, 17 Sept 2023 at 5:26 am, 'Basil Okeahialam' via NIGERIAN CARDIAC SOCIETY

Dear  All,
A Nigerian living in The Gambia was seen with an intracardiac clot straddling the tricuspid valve. It failed to lyse with thrombolysis and he was left on Apixaban. His symptoms have remained and he asked to find where he can get help, maybe Surgical since medical treatment has failed. The echo image is attached. Would be glad to get feedback for him

--

Uvie Onakpoya

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Sep 17, 2023, 7:08:10 AM9/17/23
to 'femi thomas' via NIGERIAN CARDIAC SOCIETY
Patient needs surgical resection a soon as possible. There is no role for interventional cardiology here.
We shall be delighted to resect this tumour in Nigeria. 
Can be done at Ile-Ife,  Babcock, LASUTH expeditiously. 

Professor Uvie Onakpoya 
CT surgeon, 
OAUTHC, ILE-IFE 
Visiting CT surgeon,  Babcock Cardiac centre

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Account Team

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Sep 17, 2023, 8:06:17 AM9/17/23
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Motion pic would have given a better diagnosis. Looks more like a tumour because of the well defined margin.



Sent from my Galaxy
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MARTIN AGHAJI

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Sep 17, 2023, 10:53:41 AM9/17/23
to Nigerian Cardiac Society, MARTIN AGHAJI
Dear Basil,
I tried to call you to give some of my insight to this very interesting case. Seen many in the past.
PLEASE--
1-It is most likely a tumor-PET scan would help
2-May be a primary or secondary
3-Try and assess his kidneys for a propagating malignant tumor and assess the IVC< SVC<RA complex
4-Ensure there are no tumor emboli to the lungs
5-Needs urgent excision when these indices are addressed
6-Use standard protocols for patients on anticoagulants going in for open heart surgery.
7-Compulsory to ascertain if he has an associated active PFO/ASD-
8-And any other significant co-existent cardiac or valvular lesion
PROF MA C AGHAJI

On Sunday, 17 September 2023 at 05:26:34 GMT+1, 'Basil Okeahialam' via NIGERIAN CARDIAC SOCIETY <nigerian-car...@googlegroups.com> wrote:



Dear  All,
A Nigerian living in The Gambia was seen with an intracardiac clot straddling the tricuspid valve. It failed to lyse with thrombolysis and he was left on Apixaban. His symptoms have remained and he asked to find where he can get help, maybe Surgical since medical treatment has failed. The echo image is attached. Would be glad to get feedback for him

--
IMG-20230202-WA0010 (1).jpg

Basil Okeahialam

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Sep 17, 2023, 3:02:13 PM9/17/23
to Nigerian Cardiac Society, MARTIN AGHAJI
I thank you all for your prompt response. the predominant opinion tilts towards  tumour and not  clot. I swayed towards clot because of an experience which Prof KArAye mAy recall. I DID NOT SEE  A STALK, IT WAS BANG IN THE TRICUSPID VALVE RING, I INTEROGATED THE LIVER FOR  A PRIMARY MITOTIC LESION AND DREW BLANK. THE ABDOMINAL ULTRASOUND DID NOT PICK ANYTHING IN THE KIDNEYS. A CT CHEST THAT I REQUESTED TO BETTER DEFINE THE LESION WAS REPORTED AS NORMAL, TO MY UTMOST AMAZEMENT. 
I SHALL ADVISE THE CHAP TO HEAD HOME AND REPORT FIRST TO OUR CTS COLLEAGUES AT HIS MOST CONVENIENT LOCATION.
GOD BLESS US ALL.
PROF B N OKEAHIALAM  

Basil Okeahialam

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Sep 17, 2023, 3:06:49 PM9/17/23
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ECHO WITH CONTRAST NO, CT AND NOT MRI WAS REQUESTED AND IT DID NOT PROVIDE ADDITIONAL INSIGHT MORE FOR EXPERTISE THAN ANY OTHER THING. FAILURE OF THROMBOLYSIS DOES NOT COMPLETELY EXCLUDE A CLOT AS SUCH HAS BEEN REPORTED IN LITERATURE. WE LIVE AND LEARN.
PROF B N OKEAHIALAM

Basil Okeahialam

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Sep 17, 2023, 3:08:54 PM9/17/23
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I DO NOT HAVE A VIDEO CLIP. I AGREE THAT IT WOULD HAVE GIVEN A BETTER IMPRESSION. CHEERS.
PROF B N OKEAHIALAM

solomon Danbauchi

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Sep 17, 2023, 3:12:03 PM9/17/23
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Good evening Colleagues 
My take is it looks more of tumour than a cloth, may carcinoid syndrome too

S S Danbauchi 
On Sun, 17 Sep 2023 at 20:08, 'Basil Okeahialam' via NIGERIAN CARDIAC SOCIETY

Basil Okeahialam

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Sep 17, 2023, 3:15:02 PM9/17/23
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I WAS COMING FROM THE MINDSET OF THE PATIENTS WE SAW WHILE YOU WERE WITH US IN JOS. WE SUCCESSFULLY THROMBOLYSED ONE. IN THE OTHER PATIENT IN WHOM WE CLEARLY DIAGNOSED PLCC, IT WAS ALSO A CLOT. REMEMBER PLCC ALTERS BLOOD RHEOLOGY TOWARDS THROMBOGENICITY. HE COULD NOT PROCURE A THROMBOLYTIC AGENT AND EVENTUALLY DIED. I GREET YOU.
PROF B N OKEAHIALAM  

Kamilu Karaye

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Sep 17, 2023, 5:33:20 PM9/17/23
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Dear Sir,
Yes I remember the case you are referring to in Jos. The decision you took given the circumstances and based on your experiences is of course right. I think going forward, surgical treatment should be the next immediate step, as you rightly mentioned.

Best regards,
Kamilu Karaye

On 17 Sep 2023, at 20:15, 'Basil Okeahialam' via NIGERIAN CARDIAC SOCIETY <nigerian-car...@googlegroups.com> wrote:



Okechukwu Ogah

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Sep 18, 2023, 12:19:30 PM9/18/23
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Well done sir.
I have seen similar cases
- Renal Cell Ca
-Lymphoma
-Colorectal Ca
In one there was tumour emboli in the IVC
I hope the man will take the advice and been seen by our surgical colleagues
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Godfrey Achillihu

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Sep 18, 2023, 12:49:57 PM9/18/23
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The size of this mass makes it impossible to be treated by any other means except surgical excision followed by histological analysis
The sooner the better to avoid risk of embolzation

On Sun, 17 Sep 2023 at 05:26, 'Basil Okeahialam' via NIGERIAN CARDIAC SOCIETY <nigerian-car...@googlegroups.com> wrote:

Dear  All,
A Nigerian living in The Gambia was seen with an intracardiac clot straddling the tricuspid valve. It failed to lyse with thrombolysis and he was left on Apixaban. His symptoms have remained and he asked to find where he can get help, maybe Surgical since medical treatment has failed. The echo image is attached. Would be glad to get feedback for him

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Onye G. Achilihu MD, FACC
Medical Director
Heartland Cardiovascular Consultants Limited. 

Basil Okeahialam

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Sep 18, 2023, 5:19:12 PM9/18/23
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WAY TO GO. I GREET YOU ALL AND APPRECIATE YOUR PROMPT INPUTS . I SHALL REACH HIM IN THE GAMBIA AND ADVISE HIS COMING HOME FOR THE NEEDFUL AS IS SAID IN NIGERIA. GOD BLESS NCS.
Prof B N Okeahialam

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