Large left atrial thrombus resection in a patient in sinus rhythm without mitral valve disease: A case report

Left atrial (LA) ball thrombi are often associated with atrial fibrillation (AF) and mitral valve disease (MVD). Differentiating between thrombi and LA tumors can be challenging.

A 63-year-old man with a prior mesh insertion for abdominal incisional hernia was admitted with fever. He was diagnosed with an abdominal mesh-related infection requiring surgical debridement. Preoperative transthoracic echocardiography revealed a 39-mm smooth mass in the LA adherent to the atrial septum. The mass was suspected to be a cardiac tumor based on the morphology. The patient underwent mass resection. Pathophysiology revealed that the mass was a thrombus, necessitating anticoagulation therapy. No recurrence of thrombus formation was reported.

In this case, a plausible factor causing the thrombus formation is the chronic mesh. Since LA thrombi can become free-floating or grow rapidly, early surgical intervention is essential to prevent thrombotic events or sudden death.

An LA thrombus should be included in the differential diagnosis when an LA mass is detected. Prompt surgical resection prevents thrombotic events and improves patient outcomes.