A case report of type 2 diabetes mellitus with biatrial thrombi and pulmonary embolism caused by atrial fibrillation: successful treatment with anticoagulant therapy

Abstract

A 75-year-old woman with a history of type 2 diabetes mellitus was admitted to our hospital with symptoms of asthenia. Laboratory results demonstrated a severe inflammatory response, abnormal kidney function, and hyperglycemia. Electrocardiography revealed atrial fibrillation. The patient was treated with antibiotics and insulin injection upon admission, and laboratory data relating to inflammation, kidney, and blood glucose level gradually improved. On the 4th day of hospitalization, chest contrastenhanced computed tomography showed the existence of masses in both atria and the right pulmonary artery. The differential diagnosis of the left atrial mass included a thrombus and a neoplasm, such as an atrial myxoma. Because surgical removal of the masses, presumed to be thrombi, was declined by the patient, anticoagulation therapy (heparin i.v. followed by warfarin) was initiated. After 12 months of anticoagulation therapy, the masses disappeared completely without systemic embolization.