Mobile left atrial round mass free floating in mitral ...€¦ · Mobile left atrial round mass...
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Mobile left atrial round mass free floating in mitral regurgitation flow mimicking a whale spray Atsuko Tahara, Nobuhiro Tahara, Akihiro Honda, Tsutomu Imaizumi Division of Cardio-Vascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume, Japan Correspondence to Dr Nobuhiro Tahara, [email protected] Accepted 10 February 2014 To cite: Tahara A, Tahara N, Honda A, et al. BMJ Case Rep Published online: [ please include Day Month Year] doi:10.1136/ bcr-2013-202725 DESCRIPTION A 77-year-old man with a history of atrial fibrilla- tion presented with bilateral loss of vision. A CT scan revealed acute cerebral infarction in the left occipital lobe. Cardiogenic embolic stroke was diagnosed. Treatment with intravenous heparin and antioxidative radical scavenger, edaravone and oral warfarin was started. Nevertheless, he developed new aphasia, right-sided paralysis and left conjugate deviation of the eyes 3 weeks later. MRI revealed a new cerebral infarction in his temporal lobe. He was admitted to our hospital for further investiga- tion and treatment. The ejection fraction of the left ventricle was measured as 79% by transthoracic echocardiography and there was moderate mitral regurgitation. Transoesophageal echocardiography revealed the presence of a 28×38 mm round mass, possibly a thrombus in the left atrium, suggesting that embolisation was the cause of the stroke ( figure 1A,B, arrows). The round mass was free floating in the mitral regurgitation flow, mimicking a whale spray above the mitral valve orifice without mural attachment ( figure 1B, arrows, arrowhead and video 1). The patient received aggressive antic- oagulation therapy, but did not undergo a surgical operation to remove the mobile mass because of a decreased level of consciousness. He died after returning to the referral hospital. A left atrial mass may result in sudden circulatory collapse. 1 Transoesophageal echocardiography imaging allows unique visualisation of masses and determination of size, shape, motion and spatial orientation within the left atrium. 2 Surgical removal of a mobile left atrial mass should be performed before the occur- rence of a fatal embolism. Figure 1 Transoesophageal echocardiography showing a round mass (A) floating in mitral regurgitation flow (B) (LA, left atrium; LV, left ventricle). Video 1 The round mass was floating in mitral regurgitation flow above the mitral valve orifice (mimicking a whale spray). Tahara A, et al. BMJ Case Rep 2014. doi:10.1136/bcr-2013-202725 1 Images in … on 8 June 2020 by guest. Protected by copyright. http://casereports.bmj.com/ BMJ Case Reports: first published as 10.1136/bcr-2013-202725 on 11 March 2014. Downloaded from
Transcript of Mobile left atrial round mass free floating in mitral ...€¦ · Mobile left atrial round mass...
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Mobile left atrial round mass free floating in mitralregurgitation flow mimicking a whale sprayAtsuko Tahara, Nobuhiro Tahara, Akihiro Honda, Tsutomu Imaizumi
Division of Cardio-VascularMedicine, Department ofMedicine, Kurume UniversitySchool of Medicine, Kurume,Japan
Correspondence toDr Nobuhiro Tahara,[email protected]
Accepted 10 February 2014
To cite: Tahara A,Tahara N, Honda A, et al.BMJ Case Rep Publishedonline: [please include DayMonth Year] doi:10.1136/bcr-2013-202725
DESCRIPTIONA 77-year-old man with a history of atrial fibrilla-tion presented with bilateral loss of vision. A CTscan revealed acute cerebral infarction in the leftoccipital lobe. Cardiogenic embolic stroke wasdiagnosed. Treatment with intravenous heparin andantioxidative radical scavenger, edaravone and oralwarfarin was started. Nevertheless, he developednew aphasia, right-sided paralysis and left conjugatedeviation of the eyes 3 weeks later. MRI revealed anew cerebral infarction in his temporal lobe. Hewas admitted to our hospital for further investiga-tion and treatment. The ejection fraction of the leftventricle was measured as 79% by transthoracicechocardiography and there was moderate mitralregurgitation. Transoesophageal echocardiographyrevealed the presence of a 28×38 mm round mass,possibly a thrombus in the left atrium, suggestingthat embolisation was the cause of the stroke(figure 1A,B, arrows). The round mass was freefloating in the mitral regurgitation flow, mimickinga whale spray above the mitral valve orifice withoutmural attachment (figure 1B, arrows, arrowheadand video 1). The patient received aggressive antic-oagulation therapy, but did not undergo a surgicaloperation to remove the mobile mass because of a
decreased level of consciousness. He died afterreturning to the referral hospital. A left atrial massmay result in sudden circulatory collapse.1
Transoesophageal echocardiography imaging allowsunique visualisation of masses and determination ofsize, shape, motion and spatial orientation withinthe left atrium.2 Surgical removal of a mobile leftatrial mass should be performed before the occur-rence of a fatal embolism.
Figure 1 Transoesophageal echocardiography showing a round mass (A) floating in mitral regurgitation flow (B) (LA,left atrium; LV, left ventricle).
Video 1 The round mass was floating in mitralregurgitation flow above the mitral valve orifice(mimicking a whale spray).
Tahara A, et al. BMJ Case Rep 2014. doi:10.1136/bcr-2013-202725 1
Images in…
on 8 June 2020 by guest. Protected by copyright.
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ase Reports: first published as 10.1136/bcr-2013-202725 on 11 M
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Learning points
▸ Mobile left atrial mass is associated with a high risk ofrecurrence of whole-body embolism, especially cardiogenicembolic stroke.
▸ Transoesophageal echocardiography imagingprovides detailed information of a mobile mass in theleft atrium.
▸ Surgical removal of a mobile left atrial massshould be performed before the occurrence of a fatalembolism.
Contributors AT, AH and NT were involved in patient care and preparedmanuscript and images. TI was in charge of patient care and final editing of themanuscript. All authors read and approved the final manuscript.
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
REFERENCES1 Fujiwara M, Watanabe H, Oguma Y, et al. A free-floating left atrial thrombus
develops intermittent entrapment in the mid-ventricle during diastole. Heart Vessels2012;27:428–31.
2 Ando T, Abe H, Ro D. Case of embolism due to a floating thrombus migrating from theleft atrial appendage to the ostium of the celiac artery. Ann Vasc Dis 2012;5:229–32.
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2 Tahara A, et al. BMJ Case Rep 2014. doi:10.1136/bcr-2013-202725
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ase Reports: first published as 10.1136/bcr-2013-202725 on 11 M
arch 2014. Dow
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Mobile left atrial round mass free floating in mitral regurgitation flow mimicking a whale sprayDescriptionReferences
