echo|case is an echocardiographic "showcase", intended to present pregnant, visual
impressive echocardiographic findings with high didactical value, seen from the point of view and experience of different
echocardiographists.
This is not a section for case reports, namely, it is not destined for unusual echocardiographic cases or cases of
excepcional occurrence.
Mobile left atrial mass
Dr. Gustavo Acosta
Jefe del Laboratorio de Ecocardiografía Cardiolab
Sanatorio Italiano
Zanotti Cavazzoni esq. España
1429 Asunción, Paraguay
Teléfono +595 (021) 210-357
A 59-year-old male patient with a history of systemic arterial hypertension and type 2 diabetes, both under therapy,
comes to the outpatient clinic with dyspnea on effort, which was getting worse in the last two weeks.
The electrocardiogram showed sinus rhythm with frequent supraventricular extrasystolia, heart rate was 75/min,
signs of left ventricular hypertrohpy were present. Transthoracic echocardiography showed a hypertrophic left
ventricle, dilated with an impairment of systolic function. Calculated ejection fraction is 40%.
A complementary finding complicated non-invasive diagnosis in this patient.
Left:
Bidimensional mode, para- sternal long axis projection. The left ventricle is hypertrophic, with impaired contractility.
Right:
an echogenic, mobile mass with inhomogeneous density can be seen in the dilated left atrium, dimensions
25 x 20 x 30 mm (arrow), with insertion on the interauricular septum.
Left:
apical four-chamber view, here inverted following a Mayo Clinic tradition. The mobile mass
in the left atrium causes a partial mitral valve obstruction during diastole.
Right:
echocardiographic diagno- sis suggest an ischemic cardio- myopathy with a concomitant left
atrial myxoma.
A differential diagnosis can be proposed: mobile thrombus in the left atrium. However, sinus rhythm make this option
more distant. The diagnosis of atrial myxoma was histologically confirmed after surgery.
References
1. Gill R, Aranki SF. Images in clinical medicine. Left atrial myxoma.
The New England Journal of Medicine 2008;358:728.
Overview
