title: Coumadin ridge mass assessed on three-dimensional transoesophageal echocardiography.
abstract: Transoesophageal echocardiography is often recommended in the evaluation of cryptogenic stroke, especially in those patients with no or few risk factors. We report the case of 66-year-old male with a history of multiple ischaemic strokes, admitted to our stroke unit following the discovery of multiple and diffuse new ischaemic lesions on a cerebral magnetic resonance imaging. Transoesophageal echocardiography led to the discovery of a very small mass attached to the tissue fold between the left superior pulmonary vein and the left atrial appendage (often referred to as"coumadin ridge"). The three-dimensional acquisition allowed detailed characterization of this mass. No other source of emboli was detected.The mass was considered to be most likely a tumour and was probably the cause of the multiple strokes. Due to the already advanced neurological disease and the small dimensions of the mass surgery was considered inappropriate. The patient was initiated on oral anticoagulants. This case highlights the importance of three-dimensional ultrasound in the detection and evaluation of intracardiac masses.
authors.affiliation: Dept. of Cardiology, Brugmann UH Brussels, Belgium. mihai.strachinaru@chu-brugmann.be
authors.forename: Mihai
authors.initials: M
authors.lastname: Strachinaru
authors.forename: Marie-Dominique
authors.initials: MD
authors.lastname: Gazagnes
authors.forename: Chiara
authors.initials: C
authors.lastname: Mabiglia
authors.forename: Isabela
authors.initials: I
authors.lastname: Costescu
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000000981:diagnostic imaging*; D002545:Brain Ischemia / Q000209:etiology; D004452:Echocardiography; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D006338:Heart Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009360:Neoplastic Cells, Circulating; D011667:Pulmonary Veins / Q000000981:diagnostic imaging*; D020521:Stroke / Q000209:etiology*