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(Circulation. 1998;98:931-932.)
© 1998 American Heart Association, Inc.

Images in Cardiovascular Medicine

Mobile Left Atrial Thrombus Associated With Mitral Stenosis

G. R. Wright-Smith, MBBS; D. J. Burstow, FRACP; R. Seymour, FRACP; C. Smith, FRACS; ; M. F. O'Brien, FRACS, FRCS

From The Prince Charles Hospital, Brisbane, Queensland, Australia, Departments of Cardiology and Cardiothoracic Surgery.

Correspondence to G.R. Wright-Smith, The Prince Charles Hospital, Department of Cardiology, Rode Road, Chermside, Queensland, 4032, Australia.

A68-year-old woman presented with a 6-week history of shortness of breath on exertion. She had longstanding mitral stenosis and atrial fibrillation and was not taking oral anticoagulants.

Thirty years previously, she reportedly had had a stroke and made a full recovery. Transthoracic echocardiography (Figure 1) demonstrated a freely mobile mass in the left atrium associated with severe mitral stenosis and mild aortic stenosis. The mass bounced around the atrium like a ball in a pinball machine.

View larger version (84K): [in this window] [in a new window]   Figure 1. Transthoracic echocardiogram showing a large, ball-shaped mass, with an echolucent center, that was freely mobile within the left atrial cavity. The mitral valve was thickened and calcified, and Doppler hemodynamics demonstrated severe mitral stenosis with a valve area of 0.8 cm2 and moderate left atrial dilatation.

At surgery, a large, unattached, completely smooth, circular thrombus (Figures 2 and 3) was removed, and the patient had a mitral valve replacement and aortic valvotomy.

View larger version (88K): [in this window] [in a new window]   Figure 2. At surgery, the mass was not adherent to the atrial wall and was easily removed from the left atrium.

View larger version (109K): [in this window] [in a new window]   Figure 3. Cut section of the mass revealed laminated thrombus, giving an onionskin appearance with central cavitation.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart . . . [Full Text of this Article]