Limits...
Atrial Thrombus in a Neonate: A Diagnostic Challenge.

Sheen A, De Oliveira ER, Kim RW, Parham D, Lakshmanan A - AJP Rep (2015)

Bottom Line: The neonate was born at 38 weeks' gestation to a 31-year-old female via cesarean section who was sent to the normal nursery.This case is unusual in that the patient had neither condition.This report underscores the importance of identification, search for etiology, and prompt therapy to prevent potential catastrophic outcomes.

View Article: PubMed Central - PubMed

Affiliation: Division of General Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine at the University of Southern California, Los Angeles, California.

ABSTRACT
Introduction Left atrial thrombus is a rare finding in a neonate. In the previous literature, atrial thrombi have been associated with catheter placement or congenital heart disease in a preterm infant. Case We report the case of a full-term neonate with no known risk factors found to have a left atrial thrombus. The neonate was born at 38 weeks' gestation to a 31-year-old female via cesarean section who was sent to the normal nursery. On postnatal day 5, the infant was noted to have low-to-medium level of oxygen saturations (∼90%) and was transferred to the neonatal intensive care unit with an echocardiogram completed on postnatal day 6 demonstrating a mobile, pedunculated mass attached to the left atrial septum with an appearance concerning for atrial myxoma. The infant underwent surgical resection on postnatal day 8 and pathology revealed the mass to be a left atrial thrombus. Discussion The rare finding of an atrial thrombus in a neonate has previously been associated with central venous catheter placement or congenital heart disease. This case is unusual in that the patient had neither condition. Although echocardiogram findings appeared more consistent with atrial myxoma, final pathology revealed a left atrial thrombus. Additionally, hypercoagulability work-up for this neonate was largely negative. This report underscores the importance of identification, search for etiology, and prompt therapy to prevent potential catastrophic outcomes.

No MeSH data available.


Related in: MedlinePlus

Hematoxylin and eosin stain of a soft tissue mass excision from the left atrium that now demonstrates calcification.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4502629&req=5

FI140042-3: Hematoxylin and eosin stain of a soft tissue mass excision from the left atrium that now demonstrates calcification.

Mentions: Preoperative transesophageal echo performed on postnatal day 8 demonstrated a 6 × 6 × 10 mm echo bright mass tethered to redundant septum primum, more consistent in appearance and location to an atrial myxoma than thrombus. The mass did not appear to interfere with mitral function or inflow. The neonate underwent resection of the left atrial mass with no intraoperative complications. Postoperative transesophageal echocardiogram showed that the mass had been successfully resected and that the left atrial appendage was completely clear. Subsequent pathology analysis revealed the mass to be a thrombus (Fig. 2). The postoperative course was uncomplicated, and the neonate was extubated and a mediastinal chest tube was removed on postoperative day 1 (Figs. 3 and 4).


Atrial Thrombus in a Neonate: A Diagnostic Challenge.

Sheen A, De Oliveira ER, Kim RW, Parham D, Lakshmanan A - AJP Rep (2015)

Hematoxylin and eosin stain of a soft tissue mass excision from the left atrium that now demonstrates calcification.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4502629&req=5

FI140042-3: Hematoxylin and eosin stain of a soft tissue mass excision from the left atrium that now demonstrates calcification.
Mentions: Preoperative transesophageal echo performed on postnatal day 8 demonstrated a 6 × 6 × 10 mm echo bright mass tethered to redundant septum primum, more consistent in appearance and location to an atrial myxoma than thrombus. The mass did not appear to interfere with mitral function or inflow. The neonate underwent resection of the left atrial mass with no intraoperative complications. Postoperative transesophageal echocardiogram showed that the mass had been successfully resected and that the left atrial appendage was completely clear. Subsequent pathology analysis revealed the mass to be a thrombus (Fig. 2). The postoperative course was uncomplicated, and the neonate was extubated and a mediastinal chest tube was removed on postoperative day 1 (Figs. 3 and 4).

Bottom Line: The neonate was born at 38 weeks' gestation to a 31-year-old female via cesarean section who was sent to the normal nursery.This case is unusual in that the patient had neither condition.This report underscores the importance of identification, search for etiology, and prompt therapy to prevent potential catastrophic outcomes.

View Article: PubMed Central - PubMed

Affiliation: Division of General Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine at the University of Southern California, Los Angeles, California.

ABSTRACT
Introduction Left atrial thrombus is a rare finding in a neonate. In the previous literature, atrial thrombi have been associated with catheter placement or congenital heart disease in a preterm infant. Case We report the case of a full-term neonate with no known risk factors found to have a left atrial thrombus. The neonate was born at 38 weeks' gestation to a 31-year-old female via cesarean section who was sent to the normal nursery. On postnatal day 5, the infant was noted to have low-to-medium level of oxygen saturations (∼90%) and was transferred to the neonatal intensive care unit with an echocardiogram completed on postnatal day 6 demonstrating a mobile, pedunculated mass attached to the left atrial septum with an appearance concerning for atrial myxoma. The infant underwent surgical resection on postnatal day 8 and pathology revealed the mass to be a left atrial thrombus. Discussion The rare finding of an atrial thrombus in a neonate has previously been associated with central venous catheter placement or congenital heart disease. This case is unusual in that the patient had neither condition. Although echocardiogram findings appeared more consistent with atrial myxoma, final pathology revealed a left atrial thrombus. Additionally, hypercoagulability work-up for this neonate was largely negative. This report underscores the importance of identification, search for etiology, and prompt therapy to prevent potential catastrophic outcomes.

No MeSH data available.


Related in: MedlinePlus