Challenging differential diagnosis, Unusual setting of medical care, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)
Andrew Chu, Thu Thu Aung, Haim Sahalon, Vivek Choksi, Hamid Feiz
(Department of Internal Medicine, Aventura Hospital and Medical Center, Aventura, FL, USA)
Am J Case Rep 2015; 16:876-881
In 1856, a Bohemian physician, Vilém Dušan Lambl, first described the presence of filiform lesions in aortic valve leaflets. Lambl’s excrescences are tiny filiform strands that arise on the line of valve closure, and result from valvular wear and tear. It is a rare cause of cardioembolic stroke that can be detected by transesophageal echocardiogram.
CASE REPORT: We encountered a 51-year-old, African-American woman with a history of recurrent strokes that we suspect may be the result of Lambl’s excrescence. The patient was treated with dual antiplatelet therapy and was recommended to have surveillance transesophageal echocardiograms at 6 months and 1 year from the time of discharge.
CONCLUSIONS: As there are no definitive guidelines for the management of patients with Lambl’s excrescences, we present a review of the current medical literature and a specific case report in an attempt to provide a better strategy for managing this condition. In our case report, we focus on the management and treatment for Lambl’s excrescence because no clear evidence has been published in the literature. Our review indicates that Lambl’s excrescence, despite its relative scarcity, should be considered in the differential diagnosis of a patient with cryptogenic stroke.
Keywords: Aortic Valve - ultrasonography, Echocardiography, Transesophageal, Female, Heart Valve Diseases - ultrasonography, Humans, Ischemic Attack, Transient - etiology, Magnetic Resonance Imaging, Middle Aged, Platelet Aggregation Inhibitors - therapeutic use