Images in Clinical Medicine

Kim Eagle, M.D., Editor

Large Left Atrial Thrombus

Bibiana Cujec, M.D., F.R.C.P.C., and Marc Baltzan, M.D., F.R.C.P.C.

N Engl J Med 1993; 328:771March 18, 1993

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Article

Figure 1 Large Left Atrial Thrombus.

This four-chamber view of the heart (Panel A) was obtained by transesophageal echocardiography in a 75-year-old man with longstanding nonvalvular atrial fibrillation who had recently had a transient ischemic attack. A large, immobile thrombus (T in the schematic drawing in Panel B) is attached to the posterior wall of the left atrium (LA). A smaller thrombus (T) is attached to the lateral wall of the right atrium (RA). A third thrombus was present in the left atrial appendage (not shown). The large left atrial mass is unlikely to be a myxoma because of the absence of a pedicle and the lack of attachment to the atrial septum in the area of the fossa ovalis. In addition, the presence of a mass in the left atrial appendage and the spontaneous echo contrast in the right atrium (not shown) are most consistent with the presence of multiple atrial thrombi. After this echocardiogram was obtained, the patient received anticoagulation. Transesophageal echocardiography performed three weeks later revealed a reduction in the size of both left atrial thrombi. RV denotes right ventricle, and LV left ventricle.

Kim Eagle, M.D.

Bibiana Cujec, M.D., F.R.C.P.C.
Marc Baltzan, M.D., F.R.C.P.C.
Department of Medicine, University of Saskatchewan, Saskatoon, SK S7N 0X0, Canada