Images in Clinical Medicine

Fatal Free-Floating Left Atrial Thrombus

Tamás Tornóczky, M.D., Ph.D., and Zeno Ajtay, M.D.

N Engl J Med 2004; 351:e25December 30, 2004

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Video

Left Atrial Thrombus.

A 68-year-old woman who had been resuscitated after cardiac arrest was admitted because of chest pain. The electrocardiogram showed atrial fibrillation and ST-segment elevation in leads II, III, and aVF, findings that indicated a recent inferior myocardial infarct. Transthoracic echocardiography showed hypokinesis of the posterior wall and a free-floating left atrial thrombus. Transesophageal echocardiography showed a dilated left atrium (42 by 63 mm) and severe mitral-valve stenosis, with a mitral-valve area of 0.8 cm², and confirmed the presence of the free-floating thrombus (Panels A and B), which caused intermittent occlusion of the mitral valve (Panel C and video clip). The patient was immediately prepared for open-heart surgery but had fatal cardiorespiratory arrest. At autopsy, the heart weighed 485 g. Examination of the left atrium (LA, Panel D) showed mitral-valve stenosis (MV) and a large, 60-mm thrombus (T) that had lodged in the left atrioventricular orifice, causing sudden death. Examination of the left ventricle (LV, Panel E) showed a recent myocardial infarct (I) of the posteroinferior wall, measuring 50 by 20 mm and adjoining the ventricular septum (S).

Tamás Tornóczky, M.D., Ph.D.
Zeno Ajtay, M.D.
Pécs University of Sciences, Pécs H-7624, Hungary

Citing Articles (3)

Citing Articles

1. 1

   Z.-H. You, W.-C. Yang, J.-D. Chen, C.-C. Lin. (2011) Giant atrial thrombus. Internal Medicine Journal 41:1a, 67-68
   CrossRef

2. 2

   Ambuj Roy, Nitish Naik, Chamarajnagar M. Nagesh, Anita Saxena. (2009) Fatal Freely Mobile Left Atrial Thrombus: Fallout of Anticoagulation?. Journal of the American Society of Echocardiography 22:7, 863.e5-863.e6
   CrossRef

3. 3

   Andres Beiras-Fernandez, Patrick Moehnle, Ingo Kaczmarek, Florian Weis, Bruno Reichart, Calin Vicol. (2008) Giant left atrial thrombus with mechanical compromise of the mitral valve. The Journal of Thoracic and Cardiovascular Surgery 136:5, 1374-1376
   CrossRef