"Tumor vascularity" in left atrial thrombus demonstrated by selective coronary arteriography

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Diagnostic Imaging

Background:

• Mitral valve disease necessitates thorough preoperative cardiac assessment.
• Left atrial masses can present diagnostic challenges, mimicking cardiac tumors.
• Coronary arteriography is a key diagnostic tool in evaluating coronary artery and cardiac structures.

Purpose of the Study:

• To report a case where coronary arteriography findings suggested a left atrial myxoma.
• To differentiate between cardiac tumors and thrombus using advanced imaging techniques.
• To highlight the importance of surgical confirmation in diagnosing left atrial masses.

Main Methods:

• Coronary arteriography was performed as part of preoperative investigations for mitral valve disease.
• Imaging analysis focused on identifying vascularity within a left atrial filling defect.
• Surgical exploration was conducted for definitive diagnosis and management.

Main Results:

• Coronary arteriography demonstrated "vascular puddles" originating from the left coronary artery within a left atrial filling defect.
• The filling defect was surgically confirmed to be a partially organized thrombus, not a myxoma.
• The imaging appearance mimicked the "tumor vascularity" often associated with cardiac myxomas.

Conclusions:

• Left atrial thrombus can exhibit imaging characteristics, such as "tumor vascularity," that mimic cardiac myxomas.
• Coronary arteriography, while useful, may require surgical correlation for accurate diagnosis of left atrial masses.
• This case underscores the potential for misdiagnosis when relying solely on imaging findings for cardiac tumors.