Simultaneous Left and Right Atrial Appendage Thrombi on Cardiac Computed Tomography.

Area of Science:

• Cardiology
• Radiology
• Medical Imaging

Background:

• Atrial appendage thrombosis is a known complication of atrial fibrillation.
• Standard imaging protocols may not always assess both atrial appendages.
• Patients with structural heart disease and atrial fibrillation are at increased risk.

Purpose of the Study:

• To report an unusual case of simultaneous bilateral atrial appendage thrombosis.
• To highlight the diagnostic utility of multiphasic cardiac CT.
• To emphasize the necessity of systematic bilateral atrial appendage assessment.

Main Methods:

• Contrast-enhanced cardiac computed tomography angiography (CT) was used for pre-procedural evaluation.
• Multiphasic imaging (arterial and delayed phases) was performed.
• Clinical assessment included evaluation of bleeding risk and current antithrombotic management.

Main Results:

• Simultaneous thrombosis was identified in both the left and right atrial appendages.
• Cardiac CT demonstrated well-defined filling defects consistent with thrombi.
• The patient, on long-term anticoagulation, remained asymptomatic and was deemed high bleeding risk, thus management was unchanged.

Conclusions:

• Multiphasic cardiac CT is valuable for pre-procedural imaging, aiding in the detection of atrial appendage thrombi.
• Systematic assessment of both the left and right atrial appendages is crucial.
• Right atrial appendage thrombus can be missed if not specifically evaluated, even in patients on anticoagulation.