Male patient with left atrial cardiac mass was in need of a quick diagnosis for individualized and effective treatment. Transthoracic echocardiography showed presence of а giant left atrial cardiac mass with atypical location for thrombus. Cardiac Magnetic Resonance (CMR) Imaging was performed for histological discrimination, and showed a large cardiac mass wall attached in the left atrium, homogeneous, with diameter of 3.4cm x 3.2cm. Late Gadolinium Enhancement sequences revealed black avascular tissue without signal, confirming the characterization of a thrombus. The patient refused hospital initiation of low molecular weight heparin treatment and started treatment with Rivaroxaban. Six weeks later he presented with NYHA class II, almost complete dissolving of the thrombus on CMR scan. Seven months from the initial CMR scan, echocardiography screen was done showing complete absence of the left atrial mass. With this case report we have demonstrated the significance of the CMR as one step further in the precise diagnostics of cardiac masses, solving critical clinical dilemma.
BACKGROUND: Cardiac magnetic resonance (CMR) as advanced diagnostic tool for the heart has been introduced in our institution since September 2019. AIM: We report on the first fifty consecutive patients using this imaging modality. METHODS AND MATERIALS: Strict protocol for CMR procedure, imaging quality assessment, contraindications, and informed consent were established. Patients selected for CMR were enrolled in a prospective registry. Visualizing the heart chambers, heart muscle and heart valves, resulted in acquiring complex imaging of the heart structure and function. When applicable, patients received gadolinium contrast agent for Late Gadolinium Enhancement (LGE). Adenosine was used for stress induced myocardial perfusion study. In this study, we report on the initial CMR procedures in the first 15 months. RESULTS: The age of the patients ranges from 17 to 82 and the number of male and female patients was well balanced. No absolute contraindications were met in any patient. Relative contraindications were noted but did not prevent from performing the scan. Different cardiac pathologies were encountered in the examined patients. Most common was the ischemic heart disease – 19 (38%). We had 15 (30%) out of 46 (92%) CMR procedures with LGE showing fibrotic scaring. Quality image assessment was scaled from poor to excellent. Most of the assessments were graded very good and good (46% and 48%), no poor, and very poor noted. CONCLUSION: CMR has been successfully introduced in Kosovo as excellent imaging tool for diagnosing and characterizing a nearly exhaustive spectrum of heart diseases.
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