(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.
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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.
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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 of undulating material (Fig 2). The mass was surgically removed and
revealed by pathological examination to be an infected thrombus
(Streptococcus, group F). The postoperative course was
uneventful.
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Figure 2. Transesophageal
echocardiographic view revealing large mass of
thrombotic material attached to previously formed thrombus of left
atrium. OTH indicates old thrombus; single arrow, fresh thrombus. Other
abbreviations as in Fig 1 .
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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 Institute, 6720 Bertner MC 1–267, Houston, TX 77030.
