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Left atrial ball-shaped thrombus mimicking myxoma detected by transthoracic echocardiography / Transtorasik ekokardiyografi ile saptanan miksoma benzeri sol atriyal top sekilli kitle.

A 67-year-old woman was admitted to our clinic for elective echocardiography. She had had a history of rheumatismal valve diseases, mitral stenosis and mild aortic regurgitation known for 2 years. Four years ago she had had a stroke episode which ended with no sequels. The patient was in congestive heart failure (NYHA class II). One year ago, elective echocardiographic examination was performed in another clinic but no left atrial mass or spontaneous contrast echo were reported. Atrial fibrillation with moderate ventricular response was detected on standard 12-lead electrocardiography. Two-dimensional transthoracic echocardiography showed moderate thickening and calcification of mitral valve leaflets, narrowing of the mitral valve opening area (0.9 [cm.sup.2] calculated using PHT method), and mild aortic leaflet thickening, mild aortic and tricuspid regurgitations. A smooth surfaced spherical mass of 2x2 cm was seen adjacent to interatrial septum (Fig. 1). It was mobile but did not protrude through mitral valve during diastole.

[FIGURE 1 OMITTED]

Because of rheumatismal mitral stenosis and atrial fibrillation history, urgent surgical operation was performed. Intracardiac mass was resected and mitral valve was replaced with number 31 bileaflet mechanical prosthetic valve. On pathologic examination, the mass was diagnosed as an organized trombus (Fig. 2).

[FIGURE 2 OMITTED]

Left atrial ball-shaped masses may be thrombi, vegetations or tumor. Treatment may be different in each of these entities, and includes antibiotics, anticoagulants or surgery (1). Transthoracic and transesophageal echocardiography are the procedures of choice for the diagnosis of cardiac mass involving left atrium (2). Especially, differentiation between myxoma and thrombus may be very difficult if the mass size is small, contours are smooth, or attachment size is ill-defined (3).

References

(1.) Tallano JV, Gadrin JM. Vegetation, tumor, mass and thrombi. In: Tallano JV, Gardin JM, editors. Texbook of Two-Dimensional Echocardiography. New York: Grune&Statton; 1993. p.239-70.

(2.) Alam M, Sun I. Transesophageal echocardiographic evaluation of left atrial mass lesions. J Am Soc Echocardiogr 1991; 4: 323-30.

(3.) Alam M. Pitfalls in the echocardiographic diagnosis of intracardiac and extracardiac masses. Echocardiogr 1993; 10: 181-91.

Address for Correspondence: Dr. Koksal Ceyhan, Gaziosmanpasa Universitesi Tip Fakultesi Kardiyoloji A.D, Tokat, Turkiye Tel.: +90 356 212 95 00 Fax: +90 356 212 94 17 E-mail: kceyhan09@yahoo.com

M. Murat Tumuklu, Erdesir Naseri *, Koksal Ceyhan, Altay Elalmis * From Departments of Cardiology and * Cardiovascular Surgery, Faculty of Medicine, University of Gaziosmanpasa, Tokat, Turkey
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Title Annotation:Original Images / Orijinal Goruntuler
Author:Tumuklu, M. Murat; Naseri, Erdesir; Ceyhan, Koksal; Elalmis, Altay
Publication:The Anatolian Journal of Cardiology (Anadolu Kardiyoloji Dergisi)
Article Type:Clinical report
Geographic Code:1USA
Date:Sep 1, 2007
Words:393
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