Unusual dilatation of the left auricle

Five cases showing unusual dilatation of the left auricle have been described. In two of these esophageal obstruction was produced—in one case so pronounced as to lead to gastrostomy. In three of these cases, the left auricle extended far to the right and formed a portion of the right cardiac border. Early in the disease, x-ray examination is essential for the correct diagnosis, but in later stages diagnosis may be suspected clinically from fairly suggestive physical findings. The symptoms, physical findings, pathology, and vascular dynamics of this condition are reviewed. It is practically always seen in rheumatic hearts, with mitral stenosis and auricular fibrillation. The exercise tolerance and lack of congestive failure in some of these cases are quite remarkable.     

Extreme dilatation of the left auricle to the right

Two cases of extreme dilatation of the left auricle toward the right are described. The symptoms, physical signs, and diagnosis are discussed, and the x-ray appearances are described in detail. Deviation of the esophagus to the right at the upper level of the dilated auriele is characteristic. In the early stages diagnosis is possible only by means of x-ray examination, but in the later stages suggestive signs and symptoms may appear. The condition is almost always met with in association with mitral stenosis and auricular fibrillation, and usually with adherent pericardium. A pathological specimen exemplifying the condition is described and portrayed.     

Thrombosis of the left auricle. Diagnostic usefulness of two-dimensional echocardiography

The purpose of this study is to determine the sensitivity and specificity of two dimensional echocardiography in the diagnosis of thrombosis of the left atrial appendage. Sixty patients with mitral rheumatic heart disease were examined prospectively 24 to 72 hours prior to cardiac surgery. Two images were used to identify thrombosis in the appendage: parasternal short axis at the level of the aortic valve with a lateral and superior inclination of the transducer and a modified apical five chamber view with counter clockwise rotation of the transducer between the apical long axis and the five chamber view. Diagnosis was corroborated during surgery and by histopathological analysis. In all cases the presence and predominance of mitral lesion (stenosis or regurgitation) were established by clinical history, electrocardiogram, chest roentgenogram and two dimensional echocardiogram. In 58 patients the lesions were also confirmed by cardiac catheterization. Of the 60 patients (46 females and 14 males between 16 and 61 years of age), eleven cases (18.3%) of left atrial thrombosis were detected, of which seven had formed in the left atrial appendage. All were confirmed during surgical intervention and pathological analysis. One thrombus in the left atrial appendage not diagnosed by echocardiography was found during surgery (Sensitivity:90.9%). In this case pathology studies demonstrated recently formed thrombi. In all cases in which two dimensional echocardiography did not show signs suggesting thrombosis, surgery confirmed that atrial thrombosis did not exist (Specificity: 100%). This study demonstrates the utility of two dimensional echocardiography in the diagnosis of thrombosis of the left atrial appendage, thus making it possible to schedule corrective surgery and the use of anticoagulants.