Detection of round floating left atrial thrombus simulating left atrial myxoma by two-dimensional echocardiography

Calcified amorphous tumor of the heart (cardiac CAT)

Eleven cases of poorly characterized nonneoplastic endocardially based intracavitary cardiac masses have been seen at the Mayo Clinic between 1965 and 1994. They occurred in 7 women and 4 men from age 16 to 75 years (mean, 52 years). The patients presented with a wide variety of symptoms and underlying diseases. The lesions were diagnosed as a primary cardiac neoplasm in 6 of 8 patients having echocardiography. Surgical excision was the treatment of choice in 10 patients; the 11th patient died of noncardiac causes 30 days after the mass was discovered. Grossly, the lesions were firm, yellow-white, and partially calcified, and arose in any of the four chambers. Microscopically, all lesions were characterized by nodular calcium in a background of degenerating blood elements and chronic inflammation. All patients had a benign course relative to their cardiac lesion. Repeat echocardiogram in two patients showed residual calcium in the region of the initial tumor. Although these lesions may represent calcified thrombi, the clinical presentation did not suggest thrombosis as the most likely explanation for their occurrence. Based on the combined clinical presentation and microscopic appearance, the authors propose the descriptive name calcified amorphous tumors (cardiac CAT) to describe this group to nonneoplastic cardiac masses.

The transesophageal echocardiographic diagnosis of left atrial myxoma simulating a left atrial thrombus in the setting of mitral stenosis

We report a case of left atrial myxoma simulating a thrombus on transthoracic echocardiography, but correctly diagnosed using transesophageal echocardiography. As this tumor is usually fatal unless surgically resected, a correct diagnosis is essential. Myxomas which do not prolapse between the mitral valve leaflets and coexist with mitral stenosis may be difficult to diagnose accurately using transthoracic echocardiography. The advantages of transesophageal compared with transthoracic echocardiography in the diagnosis of nonclassical left atrial myxoma are discussed.

Left atrial ball thrombus: review of clinical and echocardiographic manifestations with suggestions for management

Left atrial ball thrombus is an infrequent clinical syndrome, which can have a catastrophic outcome but can be readily treated when recognized. It is usually a complication of long-standing rheumatic mitral stenosis. Symptomatic presentation is variable: fragmentation of the thrombus followed by peripheral embolization will produce ischemia or infarction of myocardium, brain, viscera, or extremities; random, intermittent, partial, or total occlusion of the mitral valve orifice may cause syncope, pulmonary congestion, and occasionally sudden death in other patients. Embolic and obstructive phenomena may also occur together. Cardiac physical findings usually suggest mitral stenosis; variability in the intensity of the diastolic rumble is common. Two-dimensional echocardiography is the gold standard for identifying ball thrombus. Cardiac catheterization provides assessment of coronary artery status when needed. The outcome of untreated ball thrombus is unlikely to be favorable. The results of anticoagulation and thrombolysis are unpredictable and potentially as harmful as no treatment at all. Current evidence although scant suggests that prompt surgical removal of the free thrombus, often in conjunction with mitral valve repair or replacement, is the appropriate therapeutic course in most patients.