Atrial thrombus masquerading as atrial myxoma: Preliminary analysis of echocardiographic findings

We retrospectively analyzed the echocardiographic findings of 8 patients with atrial thrombus (AT). This study was conducted in Yijishan Hospital between January 2019 and September 2021. Of the 8 patients, right atrial mass was detected in 4 patients, and left atrial mass was detected in the rest 4 patients. All masses were initially diagnosed as myxoma, which were later confirmed as thrombus. Athough echocardiography can provide significant information about the nature of atrial mass in many patients, a small percentage of atrial masses remain difficult to make a qualitative diagnosis.

Delayed gastric perforation following nasogastric tube insertion: the pitfalls of radiographic confirmation

A man in his 70s, admitted to intensive care unit following an out of hospital cardiac arrest, had a nasogastric (NG) tube inserted on admission. Correct placement of the NG tube had been confirmed using National Patient Safety Agency (NPSA) criteria and was used for feeding without incident. He remained intubated and ventilated throughout his stay. On day 9 his oxygen requirements increased with subsequent chest imaging revealing an incidental gastric perforation secondary to NG tube migration. The NG tube was removed intact and undamaged. The patient appeared to improve without sequelae from the perforation or signs of abdominal sepsis. Unfortunately his condition deteriorated due to a large right atrial thrombus and life sustaining treatments were withdrawn.

C1. A “ Ping-Pong ” Ball Left Atrial Thrombus Mimicking Left Atrial Myxoma : A Case Report

Background Valvular heart disease has a high prevalence, especially in developing countries, even though there is actually no exact number for prevalence in Indonesia. The prevalence of left atrial thrombus is around 17% in patients with severe mitral stenosis and will increase about 2 times in patients with atrial fibrillation. Although left atrial thrombus is common in mitral stenosis, left atrial thrombus mimicking myxoma is rarely reported Case Summary 47-year-old woman came to Dr. Soetomo cardiology outpatient clinic. She complained of palpitation and shortness of breath. Her electrocardiogram was showed atrial fibrillation. Echocardiography showed severe mitral stenosis and free moving, round shape, left atrial mass. She then immediately planned for Mitral Valve Replacement (MVR) surgery and evacuation of the mass. We found a solid wall spherical mass, layered and easily separate. Microscopic examination revealed extensive fibrin, hemorrhage and mononuclear inflammatory cells with the conclusion of a thrombus Discussion Left atrial thrombus and myxoma often look the same on echocardiography, especially when the thrombus is free-moving and round shape. Echocardiography in this case showed a free-moving mass, round shape, like a "ping-pong" ball. The mass also has solid wall suggesting a myxoma. After surgery, we found tha the mass is multilayered which looks like a myxoma. However, microscopically confirmed that the mass is a thrombus. This suggests that a left atrial thrombus may mimicking a myxoma on echocardiography. Therefore, the gold standard for diagnosing intracardiac mass is by histopathology

Right Atrial Thrombus in a Patient of Rheumatic Heart Disease with Severe Mitral Regurgitation: A Rare Association

Conclusion: Treating physicians should be aware of the possibility of right atrial thrombus in rheumatic mitral valve disease because of its clinical implications, like life-threatening pulmonary embolization and need of surgical management.

Nomogram to Predict Left Atrial Thrombus or Spontaneous Echo Contrast in Patients With Non-valvular Atrial Fibrillation

Background: The predictive power of the CHADS2 and CHA2DS2-VASc scores for the presence of Left atrial thrombus (LAT)/ spontaneous echo contrast (SEC) in non-valvular atrial fibrillation (NVAF) is modest. The aim of this analysis is to define clinical and ultrasonic variables associated with LAT/SEC and to propose nomograms for individual risk prediction.Methods: Data on 1,813 consecutive NVAF patients who underwent transesophageal echocardiography (TEE) from January 2016 to January 2021 were collected. The univariate and multivariate logistic regression analyses were used to construct a nomogram. We examined the predictive ability of the risk scores by calculating the area under the curve (AUC). Moreover, the performance of the nomogram was assessed with respect to calibration, discrimination, and clinical usefulness.Results: LAT/SEC was found in 260 (21.0%) and 124 (21.6%) patients in the training and validation cohorts, respectively. On multivariate analysis, independent factors for LAT/SEC were Age, left atrial diameter (LAD), left ventricular ejection fraction (LVEF), hypertension (HTN), previous stroke or transient ischemic attack, Non-paroxysmal AF and a nomogram was built based on these variables. The calibration curve for the probability of LAT/SEC showed good prediction agreement with actual observation. The nomogram achieved good concordance indexes of 0.836 and 0.794 in predicting LAT/SEC in the training and validation cohorts, respectively. Decision curve analysis demonstrated that the nomogram would be clinically useful.Conclusions: In this study, a nomogram was constructed that incorporated six characteristics of NVAF patients. The nomogram may be of great value for the prediction of LAT/SEC in NVAF patients.

Diagnostic accuracy of D-dimer to detect left atrial thrombus in patients with atrial fibrillation: a systematic review and meta-analysis

Background There is limited evidence on the use of biomarkers to diagnose left atrial thrombus in atrial fibrillation. Purpose We evaluated the diagnostic accuracy of D-dimer to detect left atrial thrombus in patients with atrial fibrillation. Methods We searched four electronic databases from inception to December 16, 2020 for observational studies evaluating diagnostic accuracy of D-dimer. Reference standard was left atrial thrombus detected by transesophageal echocardiography. Study quality was assessed with the QUADAS-2 tool. We performed a bivariate random-effects meta-analysis to calculate the pooled sensitivity and specificity with their 95% confidence intervals (95% CI). In addition, a summary receiver operating characteristic curve and optimal cut-off were estimated. Results Eleven cross-sectional studies involving 4380 patients were included. The mean age ranged from 49.8 to 74.1 years and 70% of patients were men. Left atrial thrombus was present in 7% of cases. In seven studies, the pooled sensitivity of D-dimer at 500 ng/mL was 53% (95% CI, 26–79%) and the pooled specificity was 92% (95% CI, 80–97%). The pooled sensitivity of age-adjusted D-dimer was 35% (95% CI, 18–57%) and the pooled specificity was 100% (95% CI, 100–100%) in two studies. The optimal cut-off was 390 ng/mL in 10 studies with a pooled sensitivity of 68% (95% CI, 44–85%) and a pooled specificity of 73% (95% CI, 54–86%). The risk of bias was low or unclear for all domains. Concerns regarding applicability were generally low for almost all studies Conclusion Our meta-analysis suggests that D-dimer has the potential to be useful to the detection of left atrial thrombus in patients with atrial fibrillation. FUNDunding Acknowledgement Type of funding sources: None.