Inter-atrial Septal Thrombus without PFO

Abstract

Right atrial thrombi may be detected in patients with either atrial fibrillation or patent foramen ovale (PFO). We herein describe a rare case of right atrial thrombus which occurred on an apparently intact intra-atrial septum.A 48-year old woman was admitted to our hospital because of septic multiple systemic (coronary and cerebral) emboli. ECG revealed ST elevation and a Q wave in V2-6. Brain CT showed multiple cerebral emboli. Transthoracic echocardiography revealed hypokinesis of the ventricular septum. The right atrium was not dilated. Transesophageal echocardiography revealed a low echoic mass attached to the right atrial side of the inter-atrial septum (Picture 1A). After anticoagulation therapy (intravenous heparin 10,000 IU/day for 20 days), the size of the mass gradually decreased (Picture 1B) and it finally disappeared (Picture 1C). Neither PFO nor an atrial septal aneurysm was thereafter detected (Picture 2).Right atrial endothelial damage as a result of bacteremia and/or a hypercoagulable status might have contributed to thrombus formation in this case. The authors state that they have no Conflict of Interest (COI).