Images in Clinical Medicine
Floating Left Atrial Thrombus
N Engl J Med 2002; 347:e5November 7, 2002
- Article
Video
Echocardiographic Study.
Figure 1 A 71-year-old woman with a one-year history of dyspnea on exertion presented to the emergency department with worsening shortness of breath. Physical examination demonstrated rapid atrial fibrillation and a grade 4/6 holosystolic murmur of mitral-valve regurgitation. Transthoracic echocardiography revealed a thickened mitral valve with regurgitant flow and a round mass moving about randomly in the left atrium (Panel A and video clip). At surgery, a perfectly round mass the color of a partially ripe plum was found lying free in the left atrium (Panel B) and was removed from the atrial cavity. Gross examination of the specimen revealed a spherical mass 3.2 cm in diameter, which was subsequently confirmed to be a thrombus. There was also thrombus protruding from the left atrial appendage and thickened mitral-valve leaflets with rolled edges and fused commissures, findings consistent with the presence of rheumatic mitral-valve disease. A mitral-valve commissurotomy was performed, and the left atrial appendage was ligated.
John R. Doty, M.D
Johns Hopkins Hospital, Baltimore, MD 21287Donald B. Doty, M.D.
LDS Hospital, Salt Lake City, UT 84103
