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Left atrial intramural hematoma after removal of atrial myxoma: cardiac magnetic resonance in the differential diagnosis of intra-cardiac mass.

Lee HS, Kim HK, Park EA, Kim KH, Kim YJ, Sohn DW - J Cardiovasc Ultrasound (2014)

Bottom Line: Recently, cardiac magnetic resonance (CMR) has been introduced as a modality to perform different roles to existing imaging modalities, such as echocardiography.Given that CMR can provide information on tissue characteristics, it may give incremental information to TEE.We here present a rare case of LA dissection following LA myxoma removal, where CMR can make a correct diagnosis and guide management strategy.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.

ABSTRACT
Left atrial (LA) dissection is a rare entity, which is, in most cases, observed after valvular intervention. Transesophageal echocardiography (TEE) is considered to be a modality of choice in the diagnosis of LA dissection. However, LA dissection might be missed clinically in the absence of significant hemodynamic changes, and moreover physicians are occasionally reluctant to perform TEE due to its semi-invasiveness. Recently, cardiac magnetic resonance (CMR) has been introduced as a modality to perform different roles to existing imaging modalities, such as echocardiography. Given that CMR can provide information on tissue characteristics, it may give incremental information to TEE. We here present a rare case of LA dissection following LA myxoma removal, where CMR can make a correct diagnosis and guide management strategy.

No MeSH data available.


Related in: MedlinePlus

Echocardiography is a diagnostic tool of choice for left atrial dissection. Left atrium occupied by a newly developed mass (arrow) was found in parasternal long axis on postoperative day 4.
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Figure 1: Echocardiography is a diagnostic tool of choice for left atrial dissection. Left atrium occupied by a newly developed mass (arrow) was found in parasternal long axis on postoperative day 4.

Mentions: On postoperative day 4, TTE was performed to look into her overall postoperative condition, and unexpectedly a new large mass occupying the entire LA was found (Fig. 1). It minimally increased transmitral pressure gradient. Follow-up thoraco-abdominal CT angiographic findings were in line with that found on TTE (Fig. 2). Since newly detected LA mass on CT had 60 Hounsfield units, it was hard to identify what the mass was. It only gave us little information on the real nature of the mass, thrombus versus recent bleeding. For the diagnostic confirmation, thus, CMR was undergone, and showed a 5.4 × 4.4 × 4.0 cm-sized ovoid mass adjacent to the posterior and inferior wall of LA with obtuse angle. It was covered by fibrous smooth wall, meaning intramural rather than intra-atrial condition. Gadolinium enhancement was not observed on early post-contrast T1-weighted images. The mass showed low signal intensity on long-time interval delayed enhancement sequence, and displayed intermediate signal intensity on T1-weighted images and a high signal intensity on T2-weighted images, highly suggestive of acute hematoma, rather than recent bleeding (Fig. 3). Since her vital sign was stable and she was totally asymptomatic, conservative management and close medical follow-up were recommended without additional invasive procedures, and then after a few days of monitoring, she was uneventfully discharged on the post-operative day 8. She has been doing well after discharge, and any other complication was not observed on regular exam. The size of LA intramural hematoma was getting smaller and transmitral pressure gradient decreased on TTE which was performed on the postoperative day 50 (Fig. 4). CMR performed 5 months after index operation demonstrated that LA intramural hematoma finally disappeared (Fig. 5).


Left atrial intramural hematoma after removal of atrial myxoma: cardiac magnetic resonance in the differential diagnosis of intra-cardiac mass.

Lee HS, Kim HK, Park EA, Kim KH, Kim YJ, Sohn DW - J Cardiovasc Ultrasound (2014)

Echocardiography is a diagnostic tool of choice for left atrial dissection. Left atrium occupied by a newly developed mass (arrow) was found in parasternal long axis on postoperative day 4.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4286642&req=5

Figure 1: Echocardiography is a diagnostic tool of choice for left atrial dissection. Left atrium occupied by a newly developed mass (arrow) was found in parasternal long axis on postoperative day 4.
Mentions: On postoperative day 4, TTE was performed to look into her overall postoperative condition, and unexpectedly a new large mass occupying the entire LA was found (Fig. 1). It minimally increased transmitral pressure gradient. Follow-up thoraco-abdominal CT angiographic findings were in line with that found on TTE (Fig. 2). Since newly detected LA mass on CT had 60 Hounsfield units, it was hard to identify what the mass was. It only gave us little information on the real nature of the mass, thrombus versus recent bleeding. For the diagnostic confirmation, thus, CMR was undergone, and showed a 5.4 × 4.4 × 4.0 cm-sized ovoid mass adjacent to the posterior and inferior wall of LA with obtuse angle. It was covered by fibrous smooth wall, meaning intramural rather than intra-atrial condition. Gadolinium enhancement was not observed on early post-contrast T1-weighted images. The mass showed low signal intensity on long-time interval delayed enhancement sequence, and displayed intermediate signal intensity on T1-weighted images and a high signal intensity on T2-weighted images, highly suggestive of acute hematoma, rather than recent bleeding (Fig. 3). Since her vital sign was stable and she was totally asymptomatic, conservative management and close medical follow-up were recommended without additional invasive procedures, and then after a few days of monitoring, she was uneventfully discharged on the post-operative day 8. She has been doing well after discharge, and any other complication was not observed on regular exam. The size of LA intramural hematoma was getting smaller and transmitral pressure gradient decreased on TTE which was performed on the postoperative day 50 (Fig. 4). CMR performed 5 months after index operation demonstrated that LA intramural hematoma finally disappeared (Fig. 5).

Bottom Line: Recently, cardiac magnetic resonance (CMR) has been introduced as a modality to perform different roles to existing imaging modalities, such as echocardiography.Given that CMR can provide information on tissue characteristics, it may give incremental information to TEE.We here present a rare case of LA dissection following LA myxoma removal, where CMR can make a correct diagnosis and guide management strategy.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.

ABSTRACT
Left atrial (LA) dissection is a rare entity, which is, in most cases, observed after valvular intervention. Transesophageal echocardiography (TEE) is considered to be a modality of choice in the diagnosis of LA dissection. However, LA dissection might be missed clinically in the absence of significant hemodynamic changes, and moreover physicians are occasionally reluctant to perform TEE due to its semi-invasiveness. Recently, cardiac magnetic resonance (CMR) has been introduced as a modality to perform different roles to existing imaging modalities, such as echocardiography. Given that CMR can provide information on tissue characteristics, it may give incremental information to TEE. We here present a rare case of LA dissection following LA myxoma removal, where CMR can make a correct diagnosis and guide management strategy.

No MeSH data available.


Related in: MedlinePlus