Venous thromboembolism associated splenic and renal infarction in a patient with peripartum cardiomyopathy

Excerpt

A 33-year-old woman with no history of previous cardiovascular disease other than hypertension, presented to the emergency department 3 months after full-term spontaneous vaginal delivery. She complained of diffuse abdominal pain for 2 weeks that got worse on the day of presentation, and was associated with nausea, vomiting, and diaphoresis. The physical examination was significant for tenderness in the left upper and left lower abdominal quadrants. Computed tomography (CT) of her abdomen and pelvis revealed multiple wedge-shaped infarctions in the spleen (Fig. 1a) and in both kidneys (Fig. 1b). The celiac, splenic, and superior mesenteric arteries appeared patent. She was started on therapeutic anticoagulation considering the embolic nature of the infarctions. To find the source of the emboli, she had transthoracic echocardiogram (TTE), which showed global hyperkinesia of the left ventricle (LV) with an ejection fraction (EF) of 15% and a severely dilated left atrium. A nuclear cardiac stress test was negative for ischemic cardiomyopathy. Transesophageal echocardiography (TEE) did not show intracardiac thrombus. The splenic and renal infarcts were attributed to peripartum cardiomyopathy (PPCM) and the hypercoagulable state of pregnancy as she did not have any dysrhythmia, and work up for any other hypercoagulable disease was negative. She was discharged home on warfarin, aspirin, carvedilol, and lisinopril. Repeated echocardiography 10 weeks later showed normal left ventricular systolic function with an EF of 55%. Warfarin, aspirin, and carvedilol were discontinued.

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