UNUSUAL CASE OF LARGE INTRACARDIAC THROMBUS COMPLICATES A COVID-19 INFECTION

Background: Corona virus disease (COVID-19) is a viral infection, reported to increase the risk of thromboembolic diseases. We report a patient who had a COVID-19 infection and incidentally found to have right ventricle thrombus. Case: A 47-year-old male with no past medical history presented with worsening shortness of breath required intubation and later tested positive for COVID-19 infection. His initial work up which included CTA to rule out pulmonary embolism, identified RV thrombus. TTE confirmed a moderately dilated RV with two thrombi attached to interventricular septum measured 1.4 x 1.6 cm and 1.3 x 1.5 cm. Doppler ultrasound was negative for lower extremity DVT. Patient was managed medically with a plan to repeat TTE in 3 months. Decision - making: Although COVID-19 infection primarily affects the lower respiratory system, it is associated with significant cardiovascular complications including acute myocardial injury, cardiomyopathy, arrhythmias, and vascular thrombosis. Occurrence of ventricular thrombus is unusual and few cases have been reported. Exact mechanism remains poorly understood and attributed to either direct myocardial injury or increased coagulability state. Conclusion: COVID-19 infection reportedly linked to increased coagulability state. Those who had a myocardial injury increasingly reported to develop intracardiac thrombus. Early use of anticoagulation to mitigate this risk remains to be elucidated.