title: Left atrial giant thrombus infected by Escherichia Coli. Case report.
abstract: BACKGROUND
  Left atrial thrombi are mostly related to mitral valve disease. The differential diagnosis of clots and myxomas in the left atrium is mostly based on echocardiography. Infection of intracardiac thrombi is extremely rare and mostly reported in ventricular clots or aneurysms following myocardial infarction.
  
  
  METHODS
  We present the case of a 65 year old female with a history of mitral valve disease and chronic atrial fibrillation who suffered repeated embolic strokes and a giant infected clot in the left atrium. Although the patient underwent prompt surgery with removal of the clot and valve replacement the complication of septic emboli to the CNS led her to death. To the best of our knowledge this is the second report of an infected left atrial thrombus.
  
  
  CONCLUSIONS
  The case is a representative example of a neglected and undertreated patient with catastrophic consequences. Anticoagulant therapy in patients with mitral valve disease and atrial fibrillation should be applied according the currently available guidelines and standards in order to avoid analogous paradigms in the future. Mitral valve substitution should be considered in patients with mitral valve disease presenting thromboembolic complications. Surgery should be considered as the treatment of choice in cases of organized left atrial thrombus and suspected tumor or infected mass.
authors.affiliation: Cardiothoracic Surgery Department, University of Patras, Greece. drpanos@altecnet.gr
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Dedeilias
authors.forename: Antonios
authors.initials: A
authors.lastname: Roussakis
authors.forename: Efstratios N
authors.initials: EN
authors.lastname: Koletsis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Zervakis
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Hountis
authors.forename: Christos
authors.initials: C
authors.lastname: Prokakis
authors.forename: Christina
authors.initials: C
authors.lastname: Balaka
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Bolos
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D017548:Echocardiography, Transesophageal; D004926:Escherichia coli / Q000302:isolation & purification*; D004927:Escherichia coli Infections / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D017809:Fatal Outcome; D005260:Female; D006325:Heart Atria; D006331:Heart Diseases / Q000209:etiology* / Q000382:microbiology / Q000628:therapy; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008946:Mitral Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D013927:Thrombosis / Q000209:etiology* / Q000382:microbiology / Q000628:therapy; D014057:Tomography, X-Ray Computed
chemical_list: D000900:Anti-Bacterial Agents