Fibrinous Material in a Pericardial Effusion Mimicking Intraatrial Thrombus

Skolnick, Adam H.; Perk, Gila; Kronzon, Itzhak

doi:10.1111/j.1540-8175.2008.00650.x

Cited by 4 publications

(3 citation statements)

References 4 publications

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“…Careful imaging with alternative modalities usually demonstrates that these masses correspond to either fat or fibrin. In fact, the presence of epicardial fat between the aorta and the transverse sinus is a normal variant, with a prevalence of up to 9% on cardiac CT [ [11] , [12] , [13] , [14] ].…”

Section: Discussionmentioning

confidence: 99%

Epicardial fat pad within the transverse sinus mimicking a left atrial appendage thrombus

Buttinger¹,

Dooley²,

McCready³

et al. 2021

Indian Pacing and Electrophysiology Journal

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The presence of left atrial thrombus is a contraindication to cardioversion or catheter ablation in patients with atrial fibrillation, due to the increased risk of systemic thromboembolism. Management of this situation includes changes in the anticoagulation regimen and repeat imaging tests. Accurate diagnosis of left atrial appendage thrombus is therefore essential but can sometimes be challenging. Multiple imaging modalities may sometimes be required in the setting of anatomical variations of the left atrial appendage and surrounding structures. We present the case of a patient awaiting ablation for atypical atrial flutter, who underwent a transthoracic echocardiogram that showed an echodense, mobile structure within the vicinity of the left atrial appendage, suggesting a possible thrombus. A cardiac CT demonstrated the image to correlate with an epicardial fat pad within the transverse sinus.

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Section: Discussionmentioning

confidence: 99%

Epicardial fat pad within the transverse sinus mimicking a left atrial appendage thrombus

Buttinger¹,

Dooley²,

McCready³

et al. 2021

Indian Pacing and Electrophysiology Journal

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show abstract

“…The histology of these masses has not been well defined, and they have been variably described as fat 8 and fibrin. 9 In some individuals, the LA appendage may extend onto the superior surface of the LA forming part of the floor of the TS F I G U R E 1 2 A, Transthoracic image reveals a mass which appears to be a thrombus in the left atrial (LA) appendage. B, Injection of contrast, however, demonstrates that the mass, likely fat, is located within the transverse sinus (TS).…”

Section: Transverse Sinusmentioning

confidence: 99%

“…and fibrin 9. In some individuals, the LA appendage may extend onto the superior surface of the LA forming part of the floor of the TSF I G U R E 3 Drawing of the transverse and oblique sinuses in the sagittal plane.…”

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confidence: 99%

The transverse and oblique sinuses of the pericardium: Anatomic and echocardiographic insights

Penmasta

Silbiger

2018

Echocardiography

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A number of masses and pseudomasses may be encountered during echocardiographic examination of the transverse sinus (TS) and oblique sinus (OS) of the pericardium with important clinical implications. This review discusses the clinically relevant anatomy of the pericardial sinuses emphasizing diagnostic pitfalls that may be encountered during their echocardiographic examination. | ANATOMIC CONS IDER ATIONSThe pericardial layers which cover the heart's surface are depicted in Figure 1. The outermost layer, the fibrosa, is composed of collagen fibers which resist cardiac distension. The inner surface of the fibrosa is lined by a layer of mesothelial cells, the serosa. The fibrosa together with its serosal lining is referred to as the parietal pericardium. The innermost layer of the pericardium consists of a second serosal layer, the visceral pericardium or epicardium, which rests on the surface of the myocardium. The serosa produces pericardial fluid, a plasma ultrafiltrate, which fills the pericardial space that lies between them. The pericardial space normally contains approximately 25 mL of fluid. 1,2 In contrast to the uninterrupted pericardium which surrounds the rest of the heart that surrounding the left atrium (LA) is discontinuous. This discontinuity occurs in regions where the inner and outer serosal layers fuse with one another creating a cul-de-sac, or reflection ( Figure 1). Two such reflections can be found on the surface of the LA extending between the left and right pulmonary veins. These reflections face one another thereby creating a region devoid of any pericardial covering (bare area) between them (Figures 2). The pericardial reflection just above the pulmonary veins delimits the TS which rests on the superior surface of the LA beneath the ascending aorta and pulmonary artery (Figure 3). The pericardial reflection just below the pulmonary veins delimits the OS which rests on the posterior surface of the LA anterior to the esophagus and carina (Figure 3).Last, the serosal layers of the transverse and oblique sinuses also extend onto the bases of the great vessels and pulmonary veins where they again reflect on themselves ( Figures 1C and 2); the overlying fibrosa blends with these vessels' adventitia. 1-3 | ECHOC ARDIOG R APHIC APPE AR AN CE | General features of pericardial effusionsBefore addressing the echocardiographic features unique to effusions involving the TS and OS, those related to pericardial effusions, more generally, will be discussed. Small pericardial effusions typically collect posteriorly along the diaphragmatic surface of the heart, however, as they increase in size they tend to become circumferential. 4 Hence, an anterior clear space, in the absence of a posterior clear space, is unlikely to represent a pericardial effusion and more likely indicates the presence of echolucent epicardial fat attached to the surface of the right ventricle. Large anterior fat collections (>1.5 cm) are, however, often echodense. 5 Chronic effusions, including those resulting from tuberculosis, are...

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Left Atrial Appendage Confusion: A Mobile Echodensity in a Patient With Endocarditis

Hang

Schmitt

Gonzalez

et al. 2022

Journal of Cardiothoracic and Vascular Anesthesia

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Fibrinous Material in a Pericardial Effusion Mimicking Intraatrial Thrombus

Cited by 4 publications

References 4 publications

Epicardial fat pad within the transverse sinus mimicking a left atrial appendage thrombus

Epicardial fat pad within the transverse sinus mimicking a left atrial appendage thrombus

The transverse and oblique sinuses of the pericardium: Anatomic and echocardiographic insights

Left Atrial Appendage Confusion: A Mobile Echodensity in a Patient With Endocarditis

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