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A large left atrial thrombus mimicking an atrial tumour
International Journal of Cardiology 133 (2009) e58 – e59 www.elsevier.com/locate/ijcard
Letter to the Editor
A large left atrial thrombus mimicking an atrial tumour Salvatore Patanè a,⁎, Filippo Marte a , Gianluca Di Bella b , Sebastiano Coglitore b a
Cardiologia Nuovo Presidio Ospedaliero Cutroni Zodda-Barcellona P.d.G (Me) AUSL5 Messina, Italy Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Italy
b
Received 26 August 2007; accepted 17 November 2007 Available online 9 January 2008
Abstract The discovery of a large left atrial mass obliges the clinician to perform a differential diagnosis including tumour versus thrombus, but because of morphology and mobility of the mass, always it is difficult to differentiate one from the other. We present the case of a large left atrial thrombus mimicking a large tumour in an 83-year-old Italian woman. © 2007 Elsevier Ireland Ltd. All rights reserved. Keywords: Left atrial mass; Left atrial thrombus; Left atrial tumour
1. Case report The discovery of a large left atrial mass obliges the clinician to perform a differential diagnosis including tumour [1–4] versus thrombus [5], but because of morphology and mobility of the mass, always it is difficult to differentiate one from the other [6]. We present the case of a large left atrial thrombus mimicking a large tumour in an 83-year-old Italian woman. An 83-year-old Italian woman was referred to the Cardiology Unit for a cardiovascular checkup. Blood pressure values were 120/80 mmHg, the heart rate was 80 b/min, the oxygen saturation was normal. A history of hypertension in treatment and a history of recurrent paroxysmal atrial fibrillation were present. A history of recurrent transient ischemic attack was present too. ECG showed sinus rhythm. Bidimensional transthoracic echocardiography revealed normal left ventricular dimension and function (ejection fraction was 60%), biatrial dilatation and a large left atrial mass (white arrows on panel A and B, Fig. 1) compatible with an atrial tumour. Furthermore, a moderate
⁎ Corresponding author. Cardiologia Nuovo Presidio Ospedaliero Cutroni Zodda-Barcellona P.d.G(Me) AUSL5 Messina, Via Cattafi, 98051 Barcellona Pozzo di Gotto, Messina, Italy. E-mail address: [email protected] (S. Patanè). 0167-5273/$ - see front matter © 2007 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2007.11.014
mitral and tricuspid regurgitations (arrowheads on panel B, Fig. 1) were found. A treatment with an oral anticoagulant drug was added. The patient refused proposed surgical intervention. The follow-up performed with transthoracic echocardiography (6 months later) showed complete regression of the large left atrial mass. Therefore, a diagnosis of previous atrial massive thrombus formation was found. References [1] Yuce M, Dagdelen S, Ergelen M, Eren N, Caglar N. A huge obstructive myxoma located in the right heart without causing any symptom. Int J Cardiol Jan 18 2007;114(3):405–6 [Electronic publication 2006 Apr 19]. [2] Rubinshtein R, Aravot D, Flugelman MY, et al. Pulmonary venous drainage through a highly vascularized left atrial tumor. Int J Cardiol Apr 4 2007;116(3):e76–7 [Electronic publication 2006 Nov 7]. [3] Bar H, Mereles D, Libicher M, Katus HA. Lariat-like sarcoma infiltration of the left atrium. Int J Cardiol Mar 20 2007;116(2): e51–2 [Electronic publication 2006 Oct 31]. [4] Patanè S, Marte F, Di Bella G. Revelation of left atrial myxoma during acute myocardial infarction. Int J Cardiol 2008;128:134–6. [5] Dewilde W, Ector J, Herbots L. A 3-D CT image of a left atrial thrombus sparing only the ostia of the pulmonary veins. Int J Cardiol Jul 31 2007;119(3): 408–9 [Electronic publication 2007 Jan 24]. [6] Dhawan S, Tak T. Left atrial mass: thrombus mimicking myxoma. Echocardiography Oct 2004;21(7):621–3.
S. Patanè et al. / International Journal of Cardiology 133 (2009) e58–e59
Fig. 1.
e59
Letter to the Editor
A large left atrial thrombus mimicking an atrial tumour Salvatore Patanè a,⁎, Filippo Marte a , Gianluca Di Bella b , Sebastiano Coglitore b a
Cardiologia Nuovo Presidio Ospedaliero Cutroni Zodda-Barcellona P.d.G (Me) AUSL5 Messina, Italy Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Italy
b
Received 26 August 2007; accepted 17 November 2007 Available online 9 January 2008
Abstract The discovery of a large left atrial mass obliges the clinician to perform a differential diagnosis including tumour versus thrombus, but because of morphology and mobility of the mass, always it is difficult to differentiate one from the other. We present the case of a large left atrial thrombus mimicking a large tumour in an 83-year-old Italian woman. © 2007 Elsevier Ireland Ltd. All rights reserved. Keywords: Left atrial mass; Left atrial thrombus; Left atrial tumour
1. Case report The discovery of a large left atrial mass obliges the clinician to perform a differential diagnosis including tumour [1–4] versus thrombus [5], but because of morphology and mobility of the mass, always it is difficult to differentiate one from the other [6]. We present the case of a large left atrial thrombus mimicking a large tumour in an 83-year-old Italian woman. An 83-year-old Italian woman was referred to the Cardiology Unit for a cardiovascular checkup. Blood pressure values were 120/80 mmHg, the heart rate was 80 b/min, the oxygen saturation was normal. A history of hypertension in treatment and a history of recurrent paroxysmal atrial fibrillation were present. A history of recurrent transient ischemic attack was present too. ECG showed sinus rhythm. Bidimensional transthoracic echocardiography revealed normal left ventricular dimension and function (ejection fraction was 60%), biatrial dilatation and a large left atrial mass (white arrows on panel A and B, Fig. 1) compatible with an atrial tumour. Furthermore, a moderate
⁎ Corresponding author. Cardiologia Nuovo Presidio Ospedaliero Cutroni Zodda-Barcellona P.d.G(Me) AUSL5 Messina, Via Cattafi, 98051 Barcellona Pozzo di Gotto, Messina, Italy. E-mail address: [email protected] (S. Patanè). 0167-5273/$ - see front matter © 2007 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2007.11.014
mitral and tricuspid regurgitations (arrowheads on panel B, Fig. 1) were found. A treatment with an oral anticoagulant drug was added. The patient refused proposed surgical intervention. The follow-up performed with transthoracic echocardiography (6 months later) showed complete regression of the large left atrial mass. Therefore, a diagnosis of previous atrial massive thrombus formation was found. References [1] Yuce M, Dagdelen S, Ergelen M, Eren N, Caglar N. A huge obstructive myxoma located in the right heart without causing any symptom. Int J Cardiol Jan 18 2007;114(3):405–6 [Electronic publication 2006 Apr 19]. [2] Rubinshtein R, Aravot D, Flugelman MY, et al. Pulmonary venous drainage through a highly vascularized left atrial tumor. Int J Cardiol Apr 4 2007;116(3):e76–7 [Electronic publication 2006 Nov 7]. [3] Bar H, Mereles D, Libicher M, Katus HA. Lariat-like sarcoma infiltration of the left atrium. Int J Cardiol Mar 20 2007;116(2): e51–2 [Electronic publication 2006 Oct 31]. [4] Patanè S, Marte F, Di Bella G. Revelation of left atrial myxoma during acute myocardial infarction. Int J Cardiol 2008;128:134–6. [5] Dewilde W, Ector J, Herbots L. A 3-D CT image of a left atrial thrombus sparing only the ostia of the pulmonary veins. Int J Cardiol Jul 31 2007;119(3): 408–9 [Electronic publication 2007 Jan 24]. [6] Dhawan S, Tak T. Left atrial mass: thrombus mimicking myxoma. Echocardiography Oct 2004;21(7):621–3.
S. Patanè et al. / International Journal of Cardiology 133 (2009) e58–e59
Fig. 1.
e59