Left atrial thrombus causing pulmonary embolism by passing through an atrial septal defect.
A 66-year-old woman admitted with dyspnea on exertion had atrial fibrillation and left ventricular dysfunction. Echocardiography revealed an atrial septal defect (ASD) and a soft, easily deformable thrombus in the dilated left atrium. The atrial mass suddenly disappeared on the 10th day after admission, and contrast-enhanced chest computed tomography and pulmonary blood flow scintigraphy showed that the thrombus had detached from the left atrium, floated into the right atrium through the ASD and caused pulmonary embolism. This is the first documented case of a left atrial thrombus causing pulmonary embolism by passing through an ASD. When an ASD is present, it is important to consider not only paradoxical thromboembolism (from the right to the left atrium), but also pulmonary embolism caused by thromboembolism from the left to the right atrium.
Ishihara
Yukako
Y
Third Department of Internal Medicine, Toho University School of Medicine, Ohashi Hospital, Tokyo, Japan.
Hara
Hidehiko
H
Saijo
Tomokatsu
T
Namiki
Atsushi
A
Suzuki
Makoto
M
Hirai
Hironori
H
Yamaguchi
Tetsu
T
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001157:Arterial Occlusive Diseases / Q000175:diagnosis*; D001281:Atrial Fibrillation / Q000209:etiology / Q000503:physiopathology; D017548:Echocardiography, Transesophageal; D005260:Female; D006325:Heart Atria / Q000002:abnormalities*; D006801:Humans; D011655:Pulmonary Embolism / Q000209:etiology*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D014859:Warfarin