The Phantom of the Atrium: A Case Report of a Ghosting Thrombus

Epigastric pain could be associated with typical thoracic syndromes such as myocardial infarction (MI), aortic dissection (AD), or pulmonary embolism (PE) but, in certain cases, it could be more often linked to gastric disorders such as gastroesophageal reflux disease, hiatal hernia, or other gastric disorders. The key point of the differential diagnosis could be the collection of anamnestic data performed by the clinician and the performing of laboratory blood sample tests, radiological examinations and echography in Emergency Department; still a diagnostic challenges, especially in elderly patients where symptoms could be nonspecific or overlap with previous comorbidities. It's important to maintain a high index of clinical suspicion in the face of vague symptoms in multimorbid patients and to rely on a multidisciplinary approach in an emergency setting: The early use of echocardiography is fundamental for its diagnostic value, therapeutic guidance, and evolutionary monitoring of the condition. The reported case concerns an elderly patient presenting to the Emergency Department for a suspected episode of loss of consciousness following epigastric pain with a completely unexpected and never seen before ultrasound finding.