Rare case of Congenital Left Atrial Appendage

Aneurysm- Its Multimodality Imaging

Presented by:- Sahil Garg (PG Resident)

Co Authors- Abhijit Patil, Ashish Ashtekar,

V.M Kulkarni

Department of Radiodiagnosis

Dr DY Patil Medical College , Pimpri,Pune

Clinical Profile

A 20 year old female from Pune, Maharashtra, presented in medicine OPD with

fever and breathlessness on and off with chest pain since 5 years.

Associated history of headache and weakness with pain in the lower limbs since

5 years

Patient did not delineate any past history of surgery or any hospital admission.

There was no history of joint pain or any chronic illnesses like TB, HTN, DM

and Seizures.

Patient was seronegative for HIV.

Systemic examination revealed split S2 with end systolic murmur at pulmonary

area and systolic murmur at mitral area.

 

Radiograph – AP and Lateral view

PA View PA View Left Lateral ViewLeft Lateral View

RadiographRadiograph of chest PA and left lateral revealed convex opacity between inferior border of the of chest PA and left lateral revealed convex opacity between inferior border of the

aortic knob upto upper half of left cardiac border with peripheral curvilinear calcification. The aortic knob upto upper half of left cardiac border with peripheral curvilinear calcification. The

lateral projection revealed the hilar location of the lesion below the left main stem bronchus. lateral projection revealed the hilar location of the lesion below the left main stem bronchus.

USG Findings

AA BB

USGUSG revealed partially thrombosed vascular structure communicating revealed partially thrombosed vascular structure communicating

with the left side of the heart. The residual lumen showed pulsatile flow. with the left side of the heart. The residual lumen showed pulsatile flow.

Cardiac CT

Cardiac CT revealed a partially thrombosed bilobed peripherally calcified aneurysm with its

communication to left atrial appendage.

Cardiac MRI

Non thrombosed Non thrombosed aneurysm arising aneurysm arising

from the left from the left atriumatrium

Thrombosed part of Thrombosed part of aneurysmaneurysm

LALA

LVLV

RARA

RVRV

Cardiac MRICardiac MRI revealed a partially thrombosed bilobed revealed a partially thrombosed bilobed

aneurysm of the left atrial appendage. aneurysm of the left atrial appendage.

LALA

RARA

LVLV

ANEUANEU

Diagnosis- Bilobed peripherally calcified Left atrial appendage aneurysm

Differential diagnosis –Sinus of valsalva aneurysm.

Discussion

Left Atrial aneurysms are usually secondary to mitral valve

disease.

Congenital Left Atrial Appendage aneurysm is a rare anomaly

described by Semans and Taussig in 1938.

These aneurysms mimic mediastinal or cardiac tumours on

routine radiography.

Discussion (Contd.)

Sinus of Valsalva aneurysm is a differential diagnosis for left

atrial appendage aneurysm

Cardiac and coronary CT / MR provide a conclusive diagnosis

and helps in differentiating it from sinus of valsalva aneurysm.

The syndrome, if not diagnosed and treated early may lead to

complications like systemic emboli, arrhythmias and eventually

death

Conclusion

Congenital left atrial appendage aneurysm is very rarely

reported entity.

Such cases with unusual clinical presentation may pose a

diagnostic challenge.

USG provides an easily accessible modality for confirming the

location and communication with the mediastinal vascular

structures.

Cardiac and coronary CT / MRI are the gold standard for the

diagnosis

References

Parakh N, Yadav N, Chaturvedi V, GeelaniM:Giant left atrial

appendage: Postgrad Med J 2011;87:436-437.

Gościniak E, Larysz B,Jurczyk K,Kasprzak J:Five-chambered

heart: Eur Heart J (2009).

Victor S and Nayak V: Aneurysm of the Left Atrial Appendage:

Tex Heart Inst J.2001:28(2):111-118.

Hassan M, Said K, Hamamsy I, Abdelsalam S Et al: Giant

Congenital Left Atrial Appendage Aneurysm: J Am Coll

Cardiol. 2013;61(4):478-478.

Thank You