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Prominent para-cardiac fat mimicking left atrial appendage thrombus on echocardiography: Utility of cardiac computed
Bianca Honnekeri1, Agostina M Fava2, Reza Reyaldeen2
1Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
Insights
Prominent paracardiac fat can mimic left atrial appendage thrombus on transesophageal echocardiography. Cardiac CT imaging confirmed the fat, aiding accurate diagnosis and avoiding unnecessary treatment for potential thrombus.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Transesophageal echocardiography (TEE) is standard for detecting left atrial appendage (LAA) thrombus before cardioversion.
- Accurate thrombus exclusion is critical for patient safety and effective treatment.
Observation:
- A rare case presented where prominent paracardiac fat mimicked LAA thrombus on TEE.
- The echodensity raised concern for a potential thrombus requiring further investigation.
Findings:
- Multimodality imaging, specifically cardiac computed tomography (CT), was crucial for diagnosis.
- Cardiac CT clearly delineated the paracardiac fat, distinguishing it from actual thrombus.
Implications:
- Echocardiographers must recognize rare mimics of LAA thrombus to prevent misdiagnosis.
- Integrating cardiac CT can enhance diagnostic accuracy in complex echocardiographic findings.
- This case highlights the importance of considering anatomical variations in cardiac imaging.
Abstract:
Transesophageal echocardiography is the most frequently used imaging modality for exclusion of left atrial appendage thrombus prior to cardioversion. Echocardiographers should be aware of rare conditions that may mimic left atrial appendage thrombus. Here, we describe a rare case of prominent para-cardiac fat mimicking left atrial appendage thrombus on transesophageal echocardiographic imaging. Multimodality imaging with cardiac computed tomography was instrumental in providing further anatomical delineation and characterization of the echodensity as prominent para-cardiac fat in this case.
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