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[The echocardiographic aspects of a ball thrombus in left atrium (author's transl)]
Insights
Echocardiography revealed a mobile left atrial mass initially suspected as a thrombus. Further imaging confirmed it as a ball thrombus, differentiating it from myxoma.
Area of Science:
- Cardiology
- Medical Imaging
- Pathology
Background:
- A patient with mitral stenosis-insufficiency and myocardial infarction presented with a left atrial mass.
- Distinguishing between cardiac tumors like myxoma and thrombi is clinically significant.
Observation:
- Initial M-mode echocardiography showed a mobile left atrial mass, not following the cardiac cycle, suggesting a pedunculated thrombus.
- A subsequent examination revealed cyclic movement, mimicking myxoma.
- Bidimensional echocardiography excluded peduncle-like structures, supporting a ball thrombus diagnosis.
Findings:
- The initial echocardiogram suggested an organized thrombus due to its immobility relative to the cardiac cycle.
- The mass's cyclic movement in later scans mimicked a myxoma.
- Bidimensional imaging definitively diagnosed a ball thrombus by ruling out interatrial septum attachments.
Implications:
- Accurate differentiation of left atrial masses is crucial for appropriate patient management.
- Echocardiography, particularly bidimensional imaging, plays a vital role in diagnosing cardiac masses.
- Histological confirmation remains the gold standard for definitive diagnosis of cardiac masses.
Abstract:
The echo aspects of a ball thrombus in the left atrium were examined in M-mode in a patient suffering from mitral steno-insufficiency and progressed myocardial infarct of the antero-lateral wall. The first examination revealed a mass in the left atrium which did not follow the cardiac cycle. This finding was probably due to the absence of a peduncle thus the mass was relatively free to move in the left atrium. The data, therefore, seemed to favour the diagnosis of an organized thrombus and not of myxoma. Since the thrombotic mass did not interfere with the movements of the anterior mitral valve, the reduced slope of the E-F tract could be attributed to a coexisting involvement of the valve. The second examination revealed an echocardiographic finding which could not be differentiated from a myxoma of the left atrium, because the mass possessed the cyclic movement. The bidimensional approach (mechanical Sector Scanner) gave further elements for a diagnosis of ball thrombus, since all echo reflecting formations characteristic of peduncles attached to the interatrial septum could be excluded. The histological specimen confirmed the diagnosis.