Echocardiographic findings of floating thrombus in left atrium

Left atrial thrombus in a patient with lung cancer

We describe a rare case of a 64-year-old man with left atrial thrombus and stage IB adenocarcinoma of the lung. The patient was successfully treated with simultaneous cardiac operation and lobectomy for lung cancer.

Syncope Upon Swallowing Caused by an Esophageal Hiatal Hernia Compressing the Left Atrium: A Case Report

We describe a patient with syncope associated with swallowing. This syncope was caused by transient compression of the left atrium (LA) by an esophageal hiatal hernia. Two-dimensional echocardiography demonstrated a hyperechoic mass compressing the LA from the posterior. With air insufflation of the esophagus, compression of the LA by this hernia sac was seen to increase. Pulsed and color Doppler echocardiography revealed greatly decreased velocity of blood flowing into the LA and left ventricle (LV). Thus, marked compression of the LA by an esophageal hiatal hernia can cause syncope by impeding blood flow from the LA to the LV. Echocardiography proved highly useful in diagnosis.

A Case of Ball Valve Thrombus

Ball valve thrombus is a very rare cardiac pathological entity; most case reports are postmortem. It is always associated with a very tight rheumatic mitral stenosis. The antemortem diagnosis of ball valve thrombus has become easy with the advent of echocardiography and even easier with biplane or multiplane transesophageal echocardiography, including the three-dimensional acquisition of images. We present the case of a patient with a ball valve thrombus diagnosed during routine echocardiographic examination as a prelude to surgery.

Intracardiac thrombi: frequency, location, etiology, and complications: a morphologic review--Part IV

Intracardiac thrombus may develop as a consequence of multiple underlying cardiac disorders. Valvular heart disease, in particular, rheumatic mitral stenosis is frequently associated with intracardiac thrombus. Part IV of this 5-part article on intracardiac thrombus focuses on the frequency and consequences of thrombus in valvular heart disease.

Usefulness of transesophageal echocardiography for the detection of left atrial thrombi in patients with rheumatic heart disease

Transesophageal (TEE) and transthoracic (TTE) echocardiograms were performed in 110 patients with rheumatic heart disease to evaluate the usefulness of these methods for the detection of left atrial thrombi. TEE was better than TTE for detecting left atrial thrombi (21 vs 9). The thrombi not detected by TTE were in the left atrial appendage in ten and over the left atrial posterior wall in two. Patients with left atrial thrombi had significantly smaller mitral valve area (P less than 0.01) and greater left atrial dimension (P less than 0.05) than those without. All patients with left atrial thrombi had atrial fibrillation. Thirty-one patients underwent surgical intervention and 13 were found to have left atrial thrombi. TEE detected left atrial thrombi in all 13 patients with a sensitivity of 100%, specificity of 100%, and accuracy of 100%, while TTE detected left atrial thrombi in only nine of these 13 patients with a sensitivity of 69.2%, specificity of 100%, and accuracy of 87.1%. Thus, TEE is superior to TTE for the detection of left atrial thrombi, especially for those thrombi located in the left atrial appendage and along the left atrial posterior wall.

Left atrial ball thrombus: review of clinical and echocardiographic manifestations with suggestions for management

Left atrial ball thrombus is an infrequent clinical syndrome, which can have a catastrophic outcome but can be readily treated when recognized. It is usually a complication of long-standing rheumatic mitral stenosis. Symptomatic presentation is variable: fragmentation of the thrombus followed by peripheral embolization will produce ischemia or infarction of myocardium, brain, viscera, or extremities; random, intermittent, partial, or total occlusion of the mitral valve orifice may cause syncope, pulmonary congestion, and occasionally sudden death in other patients. Embolic and obstructive phenomena may also occur together. Cardiac physical findings usually suggest mitral stenosis; variability in the intensity of the diastolic rumble is common. Two-dimensional echocardiography is the gold standard for identifying ball thrombus. Cardiac catheterization provides assessment of coronary artery status when needed. The outcome of untreated ball thrombus is unlikely to be favorable. The results of anticoagulation and thrombolysis are unpredictable and potentially as harmful as no treatment at all. Current evidence although scant suggests that prompt surgical removal of the free thrombus, often in conjunction with mitral valve repair or replacement, is the appropriate therapeutic course in most patients.

Doppler and echocardiographic diagnosis of a free-floating left atrial thrombus

We report a case of a free-floating left atrial thrombus in a patient with severe mitral stenosis diagnosed by cross-sectional echocardiography. The Doppler technique was very useful in explaining some peculiar auscultatory and clinical aspects present in this rare complication of mitral valvar stenosis.

Free-floating left atrial thrombus in hypertrophic cardiomyopathy: echocardiographic findings

We report a free-floating left atrial thrombus detected by 2-dimensional echocardiography in a patient with hypertrophic cardiomyopathy. Two-dimensional echocardiography permitted definitive diagnosis, thereby indicating emergency cardiac surgery. To our knowledge, this is the first reported detection of a free-floating left atrial thrombus by 2-dimensional echocardiography in a patient with hypertrophic cardiomyopathy.

Two-dimensional echocardiographic imaging of left atrial appendage thrombi

The utility of two-dimensional echocardiography in the diagnosis of left atrial thrombi is well documented. One major limitation of this technique, however, has been the failure to successfully image left atrial appendage thrombi. This report discusses the presumptive diagnosis in three patients of pathologically confirmed left atrial appendage thrombi using a modified short-axis parasternal two-dimensional echocardiographic view.

Variable diastolic rumbling murmur caused by floating left atrial thrombus

A 53 year old man with a history of rheumatic mitral stenosis was admitted to hospital because of recurrent fainting spells. Auscultation showed a variable diastolic rumbling murmur. Simultaneous echo- and phonocardiograms demonstrated a floating left atrial thrombus; when this passed into the left ventricular inflow tract and obstructed the mitral valve orifice the diastolic murmur disappeared.