Limits...
Left atrial mass with stalk: thrombus or myxoma?

Jang KH, Shin DH, Lee C, Jang JK, Cheong S, Yoo SY - J Cardiovasc Ultrasound (2010)

Bottom Line: A 63-year-old female was presented to emergency room with an abdominal pain.When the operation was performed, there was no mass in the left atrium.It must be a thrombus and melt away.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.

ABSTRACT
A 63-year-old female was presented to emergency room with an abdominal pain. The patient had moderate mitral valve stenosis and atrial fibrillation. Abdominal computed tomography revealed right renal infarction. Transthoracic echocardiography showed a large mobile mass in the left atrium. Transesophageal two-and three-dimensional echocardiography showed a large mobile ovoid mass with a narrow stalk attached to the left atrial septum. It was thought to be a myxoma rather than thrombus. Anticoagulation with heparin was continued. When the operation was performed, there was no mass in the left atrium. It must be a thrombus and melt away.

No MeSH data available.


Related in: MedlinePlus

Transthoracic echocardiographic image in the apical 4-chamber view showing left atrial mass indicated by arrow. LV: left ventricle, RV: right ventricle.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3021896&req=5

Figure 1: Transthoracic echocardiographic image in the apical 4-chamber view showing left atrial mass indicated by arrow. LV: left ventricle, RV: right ventricle.

Mentions: A 63-year-old female was presented to emergency room with an abdominal pain. The patient had moderate mitral valve stenosis and atrial fibrillation since one year ago. She has been treated with warfarin but she often skipped her medication. Blood pressure was 120/80 mmHg and pulse rate was 72 min. The 12-lead electrocardiogram revealed atrial fibrillation with normal ventricular response. Her international normalized ratio (INR) was 1.11. Abdominal computed tomography (CT) revealed right renal infarction. Two-dimensional transthoracic echocardiography (TTE) showed moderate mitral valve stenosis with valve area of 1.2 cm2 and an enlarged left atrium. A large mobile round mass (2-3 cm in size) was seen in the left atrium (Fig. 1). It was unclear whether the mass had any attachment to the interatrial septum. The mean pressure gradient across the mitral valve on Doppler was 6 mmHg. To confirm a diagnosis, a transesophageal two-and three-dimensional echocardiography (TEE) was performed. A large (4 cm × 2.5 cm), ovoid and heterogeneous mass was observed in the left atrium attached with a narrow stalk to the left atrial septum (Fig. 2). Three-dimensional TEE showed a more definite connection with a long stalk between the mass and atrial septum. It showed tumor-like movement with cardiac cycle (Fig. 3). There was no mass in the left atrial appendage. Because it was thought to be a myxoma rather than thrombus, surgery with mass removal and mitral valve replacement was planed. Anticoagulation with heparin was continued for 12 days because of delayed surgery. Follow-up echocardiogram could not be done before surgery. When the operation was performed, surprisingly, there was no mass in the left atrium. We concluded that the mass must be thrombus and melt away. There was no remnant structure in the left atrium. Mitral valve replacement was done (Fig. 4).


Left atrial mass with stalk: thrombus or myxoma?

Jang KH, Shin DH, Lee C, Jang JK, Cheong S, Yoo SY - J Cardiovasc Ultrasound (2010)

Transthoracic echocardiographic image in the apical 4-chamber view showing left atrial mass indicated by arrow. LV: left ventricle, RV: right ventricle.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3021896&req=5

Figure 1: Transthoracic echocardiographic image in the apical 4-chamber view showing left atrial mass indicated by arrow. LV: left ventricle, RV: right ventricle.
Mentions: A 63-year-old female was presented to emergency room with an abdominal pain. The patient had moderate mitral valve stenosis and atrial fibrillation since one year ago. She has been treated with warfarin but she often skipped her medication. Blood pressure was 120/80 mmHg and pulse rate was 72 min. The 12-lead electrocardiogram revealed atrial fibrillation with normal ventricular response. Her international normalized ratio (INR) was 1.11. Abdominal computed tomography (CT) revealed right renal infarction. Two-dimensional transthoracic echocardiography (TTE) showed moderate mitral valve stenosis with valve area of 1.2 cm2 and an enlarged left atrium. A large mobile round mass (2-3 cm in size) was seen in the left atrium (Fig. 1). It was unclear whether the mass had any attachment to the interatrial septum. The mean pressure gradient across the mitral valve on Doppler was 6 mmHg. To confirm a diagnosis, a transesophageal two-and three-dimensional echocardiography (TEE) was performed. A large (4 cm × 2.5 cm), ovoid and heterogeneous mass was observed in the left atrium attached with a narrow stalk to the left atrial septum (Fig. 2). Three-dimensional TEE showed a more definite connection with a long stalk between the mass and atrial septum. It showed tumor-like movement with cardiac cycle (Fig. 3). There was no mass in the left atrial appendage. Because it was thought to be a myxoma rather than thrombus, surgery with mass removal and mitral valve replacement was planed. Anticoagulation with heparin was continued for 12 days because of delayed surgery. Follow-up echocardiogram could not be done before surgery. When the operation was performed, surprisingly, there was no mass in the left atrium. We concluded that the mass must be thrombus and melt away. There was no remnant structure in the left atrium. Mitral valve replacement was done (Fig. 4).

Bottom Line: A 63-year-old female was presented to emergency room with an abdominal pain.When the operation was performed, there was no mass in the left atrium.It must be a thrombus and melt away.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.

ABSTRACT
A 63-year-old female was presented to emergency room with an abdominal pain. The patient had moderate mitral valve stenosis and atrial fibrillation. Abdominal computed tomography revealed right renal infarction. Transthoracic echocardiography showed a large mobile mass in the left atrium. Transesophageal two-and three-dimensional echocardiography showed a large mobile ovoid mass with a narrow stalk attached to the left atrial septum. It was thought to be a myxoma rather than thrombus. Anticoagulation with heparin was continued. When the operation was performed, there was no mass in the left atrium. It must be a thrombus and melt away.

No MeSH data available.


Related in: MedlinePlus