Left Atrial Thrombi Masquerading as Myxomas: Mini Case Series and Literature Review

Mahmoud, Osama; Haynos, William; Rollor, Joyce

doi:10.1016/j.case.2020.03.009

Cited by 4 publications

(5 citation statements)

References 43 publications

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“…In this group of patients, considering an initial strategy of systemic anticoagulation followed by repeat imaging could help to prevent unwarranted surgical interventions. However, the safety of this approach remains unconfirmed [10,11].…”

Section: Discussionmentioning

confidence: 99%

“…The precise differentiation between LATs and myxomas in patients predisposed to procoagulant conditions may not be feasible without a tissue biopsy. Given their poor response to thrombolytic therapy and the associated risk of systemic embolization, in the rare instances of giant LATs, surgical removal is considered to be the treatment of choice [10][11][12].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

An Unusual Case of Cardiac Mass: A Multimodal Approach in Diagnosis and Treatment

Rankovic-Nicic,

Dragicevic-Antonic,

Antonic

et al. 2024

Healthcare

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Diagnosing intracardiac masses poses a complex, multimodal challenge. We present the case of a 72-year-old woman with a history of rheumatic fever leading to mitral stenosis and a previous mitral valve commissurotomy who reported fatigue, weakness, and palpitations over the past three months. Echocardiography revealed a tumor (53 × 40 mm) in the enlarged left atrium, attached by a wide base to the left atrium wall, exhibiting variable densities. Computerized tomography identified a heterodense mass (53 × 46 × 37 mm) with similar attachments. Angiography showed two branches from the circumflex artery intricately associated with the mass. Despite unsuccessful embolization of the mass’ blood supply, surgical intervention including mitral valve replacement, tricuspid valve annuloplasty, and tumor removal was pursued. Pathohistological analysis confirmed the mass as a thrombus. During the postoperative follow-up, the patient presented with no complaints. Follow-up echocardiography indicated the normal function of the mechanical mitral valve prosthesis and the absence of intracardiac masses. While it remains unknown whether this neovascularization is specific to patients with severe mitral valve disease, this case highlights the diagnostic challenges of differentiating between thrombi and tumors in the context of mitral valve disease. It illustrates the critical role of multimodal imaging in elucidating the anatomical and functional relationships within the heart, thereby guiding accurate diagnosis and effective treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

An Unusual Case of Cardiac Mass: A Multimodal Approach in Diagnosis and Treatment

Rankovic-Nicic,

Dragicevic-Antonic,

Antonic

et al. 2024

Healthcare

View full text Add to dashboard Cite

show abstract

“…Biopsy of the mass with histopathological assessment remains the gold standard. Literature review by Mahmoud et al showed 24 cases of left atrial thrombi misdiagnosed as myxoma [ 13 ]. Of these cases, 20 patients had underlying hypercoagulable state [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…Literature review by Mahmoud et al showed 24 cases of left atrial thrombi misdiagnosed as myxoma [ 13 ]. Of these cases, 20 patients had underlying hypercoagulable state [ 13 ]. In our patient, administration of t-PA for the stroke most likely led to showering of emboli from the atrial thrombus leading to brachial artery thrombosis from cardiac thrombo-embolism.…”

Section: Discussionmentioning

confidence: 99%

Left Atrial Thrombus Mimicking Myxoma Secondary to Rebound Hypercoagulable State

et al. 2021

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Novel oral anticoagulants (NOACs) have made the use of anticoagulation in patients with atrial fibrillation (AFib) much more convenient and predictable. It is a very common practice to hold anticoagulation either in anticipation of surgical procedures (to prevent excessive bleeding) or in case of acute bleeding episodes. This abrupt withdrawal of anticoagulation tilts the balance in favor of pro-thrombotic state in the body. We present a case of a 60-year-old man with past medical history of AFib who abruptly discontinued his apixaban (Eliquis). This patient presented to emergency room with the complaint of weakness and numbness of left arm and left half of the face. Stroke code was activated, and patient received tissue plasminogen activator (t-PA). This resulted in significant improvement of symptoms within hours of receiving treatment. Later during the same day, patient developed numbness and tingling of fingers of left hand. On physical exam, left hand was cold to touch and radial pulse was absent. Arterial duplex revealed occluded ulnar and radial arteries. Vascular surgery performed embolectomy to establish blood flow in the radial and ulnar arteries. Transthoracic echocardiogram revealed large left atrial mass attached to the atrial septum. Most likely t-PA infusion in the setting of atrial mass led to distal showering of emboli resulting in stenosis of radial and ulnar arteries. The left atrial mass was most likely thrombus as patient had cardiac imaging including transthoracic echocardiogram and computed tomography of heart prior to these events which did not reveal any mass in left atrium. In short, as clinicians we should be aware of the hypercoagulability associated with withdrawal of anticoagulation. In addition, we should be wary of the challenges associated with differentiating cardiac masses of different etiology.

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“…[ 3 ] The imaging appearance of thrombi and sessile myxomas may mimic each other. [ 4 ] Conversely, an atrial thrombus in some cases may have a stalk, misleading clinicians into diagnosing it as a myxoma. Differentiating between them can at times become a diagnostic challenge for the intraoperative echocardiographer, which is of paramount importance in tailoring treatment strategies.…”

Section: Introductionmentioning

confidence: 99%

Delineating thrombus versus myxoma: Perioperative 3D transesophageal echocardiography to the rescue!

Badge,

Kapoor,

Thiruselvan

et al. 2024

JCIS

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Cardiac masses are a significant cause of patient morbidity and mortality by virtue of their symptoms and surgical removal. Preoperative diagnosis of a cardiac mass is usually based on clinical correlation and transthoracic echocardiography findings. Myxomas are the most common benign cardiac tumors, commonly occurring in the left atrium attached to the interatrial septum near the fossa ovalis. Although, at times atypical location and unusual morphology may pose a diagnostic dilemma with 2D echocardiography. 3D echocardiography with its multifaceted advantages, including multiplanar cropping abilities and superior imaging quality can help distinguish between a clot and a myxoma.

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Left Atrial Thrombi Masquerading as Myxomas: Mini Case Series and Literature Review

Cited by 4 publications

References 43 publications

An Unusual Case of Cardiac Mass: A Multimodal Approach in Diagnosis and Treatment

An Unusual Case of Cardiac Mass: A Multimodal Approach in Diagnosis and Treatment

Left Atrial Thrombus Mimicking Myxoma Secondary to Rebound Hypercoagulable State

Delineating thrombus versus myxoma: Perioperative 3D transesophageal echocardiography to the rescue!

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