A 72-Year-Old Woman with Dark Urine and Weakness

This case report details a 72-year-old woman who presented with progressive fatigue and dark urine following international travel and alcohol intake. Her medical history included rheumatic heart disease and long-standing mechanical mitral and aortic valve replacements managed with warfarin. Laboratory findings revealed anemia, hemoglobinuria, elevated LDH, undetectable haptoglobin, and jaundice consistent with intravascular hemolysis. Imaging and echocardiography demonstrated normal valve function but revealed acoustic shadowing and perivalvular calcification. Transesophageal echocardiography identified posterolateral mitral and aortic paravalvular leaks, the most likely cause of mechanical trauma-induced hemolytic anemia. Coronary CT angiography further characterized leak anatomy and coronary artery status. Surgical repair of the leaks led to clinical improvement and resolution of hemolysis. The case underscores diagnostic and management nuances in mechanical valve complications and the use of advanced imaging modalities in guiding treatment decisions.

This case report details a 72-year-old woman who presented with progressive fatigue and dark urine following international travel and alcohol intake. Her medical history included rheumatic heart disease and long-standing mechanical mitral and aortic valve replacements managed with warfarin. Laboratory findings revealed anemia, hemoglobinuria, elevated LDH, undetectable haptoglobin, and jaundice consistent with intravascular hemolysis. Imaging and echocardiography demonstrated normal valve function but revealed acoustic shadowing and perivalvular calcification. Transesophageal echocardiography identified posterolateral mitral and aortic paravalvular leaks, the most likely cause of mechanical trauma-induced hemolytic anemia. Coronary CT angiography further characterized leak anatomy and coronary artery status. Surgical repair of the leaks led to clinical improvement and resolution of hemolysis. The case underscores diagnostic and management nuances in mechanical valve complications and the use of advanced imaging modalities in guiding treatment decisions.