Right atrial mass after open heart surgery: tumour or thrombus?

Detection of a rapidly growing mass in the right atrium during routine inter-echocardiogram follow-up period in two patients after corrective open-heart surgery raises concerns about nature of the mass and the probable cause. One turned out to be an atrial myxoma that grew rapidly over a eight month period and the other a well encapsulate thrombus in a fully anticoagulated patient. Preoperative transthoracic echocardiogram had reported both the cases to be a myxoma. This article highlights the importance of considering rare causes in the face of a seemingly obvious diagnosis and possible use of imaging modalities in the management of these cases.     

Large atrial thrombus formation after MitraClip implantation: is anticoagulation mandatory?

Percutaneous mitral valve repair with the MitraClip system has evolved as a promising new technique for the non-surgical treatment of mitral regurgitation (MR). To date, few major adverse events have been reported in initial studies with this technique. The case is reported of a 70-year-old patient who underwent successful MitraClip implantation. Routine pre-discharge transesophageal echocardiography on day 5 after implantation showed large thrombus formation in the left atrium (posterolateral wall) and on the right atrial side of the septum. The patient had not received any anticoagulation after clip implantation, and did not have any monitored episodes of atrial fibrillation prior to the scheduled discharge day. It is concluded that mandatory anticoagulation for at least one month should be considered in patients undergoing MitraClip implantation.     

Left atrial tumour in a patient with dilated cardiomyopathy: myxoma or thrombus? A case report

A case of a 51-year-old male with dilated cardiomyopathy and left atrial mass detected by echocardiography is described. Differential diagnosis between thrombus and myoxoma was difficult. Anticoagulation therapy was initiated and no intra-atrial mass was detected during the control echocardiographic examination. Thus, the diagnosis of intracardiac thrombus was established ex iuvantibus. Difficulties in the diagnosis and treatment of intracardiac masses are discussed.     

A recurrent right atrial thrombus: a suggestive sign for Behçet's disease? A case report

A 29-year-old woman with Behçet's disease was admitted to our cardiology department with a history of cough, dyspnea, and palpitation. Transthoracic and transesophageal echocardiography revealed a right atrial mass. She was operated on to remove the mass, which was shown by histopathological examination to be a thrombus. Three months later, echocardiography was repeated and recurrent right atrial thrombus was observed. Warfarin was given to the patient. One month later, the mass was not observed on echocardiographic examination. We report recurrent right atrial thrombus in a patient with Behçet's disease.     

Is the site of thrombus formation in the left atrial appendage associated with the risk of cerebral embolism?

Atrial fibrillation (AF) is a risk factor for cerebral embolism, with the left atrial appendage (LAA) being considered as the source of emboli. However, the relationship between the histologic properties of LAA thrombi and the occurrence of cerebral embolism is not known. Seventy-six hearts from patients who died within 1 month after cerebral embolism were studied at autopsy. Patients were grouped according to the presence of AF and the presence of valvular disease (VD). We determined whether the LAA thrombi adhered to the trabecular region or the remainder of the LAA. LAA thrombi were grouped into three stages: a fresh stage in which thrombi consisted of fibrin and platelets, an organizing stage in which angiogenesis was observed in the thrombi, and an organized stage in which endothelial cells covered the surface of the thrombi. The AF+/VD- group included 19 patients (25.0%), the AF+/VD+ group 8 (10.5%), the AF-/ VD- group 37 (48.7%), and the AF-/VD+ group included 12 patients (15.8%). LAA thrombi were observed in 15 patients (78.9%) in the AF+/VD- group, and all of the thrombi adhered to the trabecular region. Thrombi in the fresh and the organizing stages were observed in 10 patients (66.7%). Patients in the AF+/VD- group accounted for about 25% of the cases of cerebral embolism. All of these thrombi were attached to the trabecular region, and about 70% of them could represent an embolic source.     

Left ventricular mass: Myxoma or thrombus?

Patient with embolic episode should always be evaluated for cardiac mass. Mass in left ventricular can be a myxoma or thrombus even in a normal functioning heart. In either case, mobile mass with embolic potential should be surgically resected.