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Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
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The clot thickens: unusual presentation of a left atrial thrombus

Stephen F Lau, James S Hood, Dorinna D Mendoza

  • 1Department of Internal Medicine, Kaiser Permanente Oakland Medical Center, Oakland, CA; Department of Cardiothoracic Surgery, Kaiser Permanente San Francisco Medical Center, San Francisco, CA; Department of Cardiology, Kaiser Permanente Oakland Medical Center, Oakland, CA; Department of Pathology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA; Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA; Department of Medicine, University of California, San Francisco, San Francisco, CA.

Reviews in Cardiovascular Medicine
|March 28, 2015
PubMed

Insights

Left atrial thrombi can cause serious heart problems. This unusual case highlights a cystic-appearing thrombus, initially mistaken for myxoma, emphasizing the importance of accurate diagnosis through imaging and pathology.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Pathology

Background:

  • Left atrial thrombi are a major source of cardioembolic events.
  • Transesophageal echocardiography (TEE) is highly sensitive and specific for visualizing atrial thrombi.
  • Cardiac magnetic resonance imaging (CMR) aids in differentiating cardiac masses.

Purpose of the Study:

  • To report an unusual case of a large, free-floating left atrial thrombus with a cystic appearance.
  • To discuss the diagnostic challenges and differential diagnoses, including atrial myxoma.
  • To emphasize the role of histopathology in confirming the diagnosis.

Main Methods:

  • Transesophageal echocardiography (TEE) for initial visualization.
  • Cardiac magnetic resonance imaging (CMR) for tissue characterization.
  • Surgical excision and subsequent histopathologic analysis of the atrial mass.

Main Results:

  • A large, free-floating left atrial mass with a cystic appearance was identified.
  • Echocardiographic and imaging findings initially suggested atrial myxoma.
  • Histopathologic analysis confirmed the mass as an atrial thrombus.

Conclusions:

  • Cystic-appearing left atrial masses can represent thrombi, posing a diagnostic challenge.
  • Accurate differentiation between thrombi and myxoma is crucial for appropriate management.
  • Histopathology remains the gold standard for definitive diagnosis of atrial masses.

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