Coronary Angiographic Finding of Thrombus in the Left Atrial Appendage

Abstract

Coronary angiography is useful in the diagnosis of LAA thrombus, and coronary neovascularity and fistula formation may indicate that the thrombus can spontaneously resolve.

Late Complication of a Large Simple Cyst of the Liver Mimicking Cystadenocarcinoma After Sclerotherapy

“…Neovasculature in the chronic thrombi in the left atrium or aortic aneurysm has been reported [8]. In our patient, a similar mechanism can be presumed to have occurred within the cyst that was reduced by sclerotherapy.…”

Left atrial appendage: structure, function, and role in thromboembolism

“…Although angiography has been used fairly extensively in the past for the investigation of thrombi in the LAA,31 this is invasive and is now rarely done. Transthoracic echocardiography does not usually afford views of the LAA; however, transoesophageal echocardiography allows semi-invasive, highly accurate imaging of the LAA and in recent years this has become a valuable tool for the diagnosis of thrombus within the appendage (figs 4 and 5).…”

Left Atrial Thrombus Masquerading as a Myxoma in a Patient with Mitral Stenosis

“…This case illustrates several important clinical points: (1) The presence of vascularity alone should not be used to distinguish a myxoma from a thrombus. (2) Angiographically detectable neovascularization is not pathognomonic for cardiac tumors and has been described with LA thrombi in the setting of mitral stenosis as well 4,5 . It is proposed that the histologically intermediate stage of thrombus formation (with invasion of vascular channels and mesenchymal cells from the underlying endothelium) is the most appropriate period for the visualization of neovascularity and a coronary artery‐LA fistula may also be seen if vascular channels reach the mural surface of the thrombus 5 .…”

“…(2) Angiographically detectable neovascularization is not pathognomonic for cardiac tumors and has been described with LA thrombi in the setting of mitral stenosis as well 4,5 . It is proposed that the histologically intermediate stage of thrombus formation (with invasion of vascular channels and mesenchymal cells from the underlying endothelium) is the most appropriate period for the visualization of neovascularity and a coronary artery‐LA fistula may also be seen if vascular channels reach the mural surface of the thrombus 5 . (3) Selective coronary angiography as a thrombus diagnostic tool is no longer necessary due to the availability of other less‐invasive methods such as TEE, Computerized Tomography, and CMR.…”

“…4,5 It is proposed that the histologically intermediate stage of thrombus formation (with invasion of vascular channels and mesenchymal cells from the underlying endothelium) is the most appropriate period for the visualization of neovascularity and a coronary artery-LA fistula may also be seen if vascular channels reach the mural surface of the thrombus. 5 (3) Selective coronary angiography as a thrombus diagnostic tool is no longer necessary due to the availability of other less-invasive methods such as TEE, Computerized Tomography, and CMR. However, these clues should not be forgotten, as the unexpected detection of coronary neovascularization or fistula formation in the LA on coronary angiography in a patient with mitral stenosis should raise suspicion for thrombus.…”