title: Conservative treatment of a left atrial intramural hematoma after left atrial thrombus resection and concomitant mitral valve replacement--case report.
abstract: Left atrial intramural hematoma is a seldom cause of left atrial mass. It has been described to occur spontaneously, after interventional procedures, after blunt chest trauma, or after aortocoronary bypass surgery. We present a case of mitral valve replacement together with the removal of a large intraatrial space-occupying lesion. Intraoperative transesophageal echocardiography confirmed a successful resection of this mass. Surprisingly, upon admission to ICU, transesophageal and transthoracic echocardiography revealed a recurrence of an intramural lesion, closest matching a hematoma, which was confirmed by contrast-enhanced computed tomography. Surgical intervention was thoroughly discussed but a conservative management was favoured. 3 months after surgery, a reassessed transthoracic echocardiography and computed tomography demonstrated an almost complete resolution of the pre-existing hematoma.
authors.affiliation: Department of Anesthesiology, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377 Munich, Germany. dirk.bruegger@med.uni-muenchen.de
authors.forename: Dirk
authors.initials: D
authors.lastname: Bruegger
authors.forename: Sebastian
authors.initials: S
authors.lastname: Sadoni
authors.forename: Mikhail
authors.initials: M
authors.lastname: Primaychenko
authors.forename: Ralf
authors.initials: R
authors.lastname: Sodian
authors.forename: Christoph
authors.initials: C
authors.lastname: Schmitz
authors.forename: Bruno
authors.initials: B
authors.lastname: Reichart
authors.forename: Daniel
authors.initials: D
authors.lastname: Chappell
mesh_terms: D000368:Aged; D017548:Echocardiography, Transesophageal; D005260:Female; D006325:Heart Atria; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006406:Hematoma / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000601:surgery; D011183:Postoperative Complications; D012075:Remission, Spontaneous; D017131:Thrombectomy / Q000009:adverse effects*; D013927:Thrombosis / Q000601:surgery*