Left atrial thrombosis in achalasia--a case report

An 81-year-old woman came to the clinic with aphasia and gait disturbance. A transthoracic echocardiogram showed left atrial (LA) thrombus at the posterobasal site, which was compressed by a large mass with high echo intensity. A chest computed tomography scan revealed dilatation of the esophagus, compressing the LA from the posterior side. An endoscopy showed a bolus and much foulness in the distended esophagus, which were immediately eliminated by an endoscopic procedure. The LA thrombus, as shown by transesophageal echocardiography, spontaneously resolved without any neurologic signs. The authors assumed that the dilatated esophagus compressed the LA, and this may have produced the abnormal flow dynamics in the LA. The injury of endocardial surface produced by the distension or turbulent flow, in addition to dehydration, may have augmented a coagulability in the LA.