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(Circulation. 1998;97:291.)
© 1998 American Heart Association, Inc.

Images in Cardiovascular Medicine

Unusual Atrial Thrombi Discovered by Transesophageal Echocardiography

Carlos M. Gaos, MD; Wayne E. Dear, MD; Eleftherios S. Stamatious, MD; ; Susan Wilansky, MD

From the Department of Adult Cardiology, Texas Heart Institute, and the Department of Echocardiography, St Luke's Episcopal Hospital, Houston, Tex.

Correspondence to Susan Wilansky, MD, St Luke's Episcopal Hospital, 6624 Fannin, Suite 2480, Houston, TX 77030.

Case Summaries

Case 1
A 58-year-old man was transferred to St Luke's Episcopal Hospital in January 1996 with persistent pleuritic chest pain. His medical history included a pulmonary embolus that had been treated with anticoagulation in December 1994. Three months later, in March 1995, multiple emboli to the right brachial, carotid, and renal arteries were discovered; at that time, an inferior vena caval filter was placed. In September 1995, an atrial septal defect was diagnosed and surgically closed. In the postoperative period, echocardiography revealed the presence of a right atrial thrombus, for which the patient received heparin and was placed on a regimen of sodium warfarin (Coumadin) therapy. At the time of admission to our hospital, transesophageal echocardiography revealed a bilobar thrombus attached to the eustachian valve (Fig 1). The thrombus was surgically removed and confirmed by postoperative pathological examination. The postoperative course was uneventful.

View larger version (60K): [in this window] [in a new window]   Figure 1. Transesophageal echocardiogram showing bilobar thrombus attached to eustachian valve. RA indicates right atrium; IVC, inferior vena cava; LA, left atrium; TH, thrombus; and E, eustachian valve.

Case 2
An 87-year-old man was admitted to St Luke's Episcopal Hospital with a 1-year history of fever, night sweats, and weight loss of 20 pounds. His previous medical history included atrial fibrillation. On admission, a blood culture was positive for Salmonella; for this, the patient received antibiotics and was discharged. Two weeks later, he was readmitted to our hospital with syncope. Transesophageal echocardiography revealed a large, fixed thrombus in the left atrium. Attached to the thrombus was a large mass . . . [Full Text of this Article]