(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.
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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.
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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.
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Figure 2. At surgery, the mass was not adherent to the
atrial wall and was easily removed from the left atrium.
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Figure 3. Cut section of the mass revealed laminated
thrombus, giving an onionskin appearance with central cavitation.
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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 Ave, MC1–267, Houston, TX 77030.
