[Diagnosis by magnetic resonance imaging of a case of intramural left atrial hematoma]

Case report and systematic review of iatrogenic left atrial dissection in different cardiovascular specialties: A common treatment for an uncommon complication?

OBJECTIVES

Left atrial dissection (LatD) is a rare and heterogeneous condition affecting many cardiovascular areas. The present article, by the means of personal case report illustration and systemic review of different clinical management, is aimed to give to clinicians further knowledge on this controversial topic.

BACKGROUND

LatD is an exceedingly rare but potentially fatal complication of cardiac surgery or catheter-based interventional procedures. Most of the cases are iatrogenic and its incidence is expected to grow due to an increase in the number of percutaneous coronary intervention and structural heart disease procedures. The management of this complication is controversial, and it may depend on related etiologies.

METHODS

We have reported our single-case experience and review of the scientific literature, focusing on the decision-making process and the strategical approach by multimodality imaging techniques.

RESULTS

Our case of LatD with initial hemodynamic instability was surgically treated. Conservative approach is often employed in literature despite the fact that conservative versus surgical approach is debatable, depending on clinical presentation, hemodynamic stability, multimodal imaging findings, and personal experience of the center.

CONCLUSIONS

According to systematic literature review, a watchful-waiting strategy supported by multimodality imaging could be a safe and effective management in stable LatD.

Spontaneous left atrial intramural hematoma associated with large hemorrhagic pericardial effusion

Atrial intramural hematoma is a rare entity. It was reported to occur spontaneously especially in patients with recent history of cardiac surgery or cardiac trauma. In this report, a case of spontaneous intramural hematoma associated with large bloody stained pericardial effusion presented with progressive shortness of breath as the primary clinical manifestation is described. The diagnosis was tentatively achieved by transesophageal echocardiography and cardiac computed tomography scan and was later confirmed during surgery. The patient recovered uneventfully following surgery and follow-up echocardiography demonstrated complete resolution of pre-existing hematoma. <Learning objective: We present a case of spontaneous intramural atrial hematoma and cardiac tamponade in a 61-year-old patient with a history of progressive shortness of breath. The proper diagnosis and surgical intervention are described. This case description will help increase the awareness regarding the diagnosis of this rare cardiac condition.>.

Left atrial intramural hematoma after removal of atrial myxoma: cardiac magnetic resonance in the differential diagnosis of intra-cardiac mass

Left atrial (LA) dissection is a rare entity, which is, in most cases, observed after valvular intervention. Transesophageal echocardiography (TEE) is considered to be a modality of choice in the diagnosis of LA dissection. However, LA dissection might be missed clinically in the absence of significant hemodynamic changes, and moreover physicians are occasionally reluctant to perform TEE due to its semi-invasiveness. Recently, cardiac magnetic resonance (CMR) has been introduced as a modality to perform different roles to existing imaging modalities, such as echocardiography. Given that CMR can provide information on tissue characteristics, it may give incremental information to TEE. We here present a rare case of LA dissection following LA myxoma removal, where CMR can make a correct diagnosis and guide management strategy.

Right atrial intramural hematoma associated with aortic dissection

A 75-year-old male presented with shortness of breath and abdominal pain; he had undergone coronary artery bypass graft surgery three months ago and had a history of coronary artery disease, hypertension, and end-stage renal disease. Transthoracic echocardiogram showed a right atrial mass. A computed axial tomography scan showed an atrial mass and type A aortic dissection. The patient sustained cardiorespiratory arrest and died. An autopsy showed an 8 cm atrial intramural hematoma originating from a dissecting aneurysm. This is the first case of right atrial intramural hematoma associated with aortic dissection exhibiting high mortality. Early diagnosis using multiple imaging modalities including magnetic resonance imaging and timely surgical intervention may improve survival. Intramural hematomas should be considered in patients presenting with right-sided cardiac lesions.