Is it a thrombus or a tumor? An imaging dilemma for clinicians

Area of Science:

• Cardiology
• Medical Imaging

Background:

• Atrial fibrillation is the most common cardiac arrhythmia, significantly increasing stroke risk.
• Thrombus formation in the left atrial appendage is a primary cause of stroke in atrial fibrillation patients.
• Early rhythm control strategies can mitigate cardiovascular events in high-risk individuals.

Observation:

• A 1 cm stalk-like lesion was identified in the left atrial appendage via transesophageal echocardiogram.
• The lesion was observed in a patient undergoing evaluation for electrical cardioversion.
• Initial imaging raised concerns for a cardiac mass.

Findings:

• Utilized cardiac magnetic resonance imaging and computed tomography for comprehensive evaluation.
• Advanced imaging modalities confirmed the lesion was a chronic resolving thrombus.
• Differentiated the lesion from other potential cardiac masses.

Implications:

• Accurate diagnosis of left atrial appendage lesions is crucial for stroke risk stratification.
• Multimodality cardiac imaging aids in characterizing thrombi versus masses.
• Understanding thrombus resolution patterns can inform clinical management strategies.