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Pulmonary Vein Stump: A Left Atrial Cardioembolic Source
Austin Deets1, Ali Ali2, Nour Ghosoun3
1Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Aurora Health Care, Milwaukee, Wisconsin, USA. Electronic address: https://twitter.com/DeetsAustin.
Background:
The left atrial appendage (LAA) is the most common nidus for thrombus formation in atrial arrythmias.
Case Summary:
We present a case of acute limb ischemia initially thought to be embolic due to LAA thrombus from atrial flutter. Transesophageal echocardiography before direct current cardioversion demonstrated a LAA without thrombus and favorable filling velocities. However, thrombus was discovered in the postsurgical pulmonary vein stump.
Discussion:
Pulmonary vein stumps are becoming recognized as a common source of intracardiac thrombus after lobectomy.
Take-Home Message:
Performing a comprehensive transesophageal echocardiography before direct current cardioversion is paramount to avoid missing thrombi outside the LAA, especially in at-risk populations.
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