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Acute Thromboembolism in Spleen Due to Clot in Left Atrial Appendages in Rheumatic Mitral Stenosis

Dr.Jayesh Trivedi MD

A 44-year-old woman was referred to our medical out door for control and management of acute abdominal pain in left hypochondrium in a patient who had Adenomyosis diagnosed by a Gynacologist. On examination patient was in sinus rhythm with auscultatory findings of Rheumatic Mitral Stenosis. She had soft rumbling mid diastolic murmur with presystolic accentuation and loud S1.Opening snap and loud pulmonary component of S2 was heard. Her Total WBC count was 15000 except this all her blood investigations were normal. She was complaining about left hypochondrium pain. Mild Splenomegaly was seen. So we carried out ECG, ASO Titre, Blood culture, chest x-ray and Transthoracic Echocardiography which showed rheumatic Mitral Stenosis without vegetations. Sonography of abdomen suspected Splenic Infarct. MRI Abdomen was carried out where diagnosis of Splenic Infarction with reduction of splenic blood flow on contrast was seen. But a clot in Heart was seen. We carried out Trans oesophageal Echocardiography which showed LAA clot. Thus the final diagnosis was made.