title: Occult left atrial ball-like thrombus in a patient referred for surgical removal of suspected cerebellum tumor.
abstract: BACKGROUND
  Atrial fibrillation and related cardio-embolic cerebrovascular accidents are two well-defined major healthcare problems worldwide. It has been approximated that 2.2 million people in America and 4.5 million in European Union have paroxysmal or persistent atrial fibrillation. And atrial fibrillation itself is an independent long-term risk factor of stroke. We present a case of patient referred to our center for surgical removal of suspected cerebellum tumor, a case that had a rather unexpected ending.
  
  
  METHODS
  A 58-year-old male patient with a history of atrial fibrillation, congestive heart failure (NYHA II/III), stable coronary artery disease, diabetes type 2 and hyperlipidemia presented with vertigo, headaches, mainly during physical activity and increased tiredness. Performed computer tomography revealed two lesions in the cerebellum and in the left lateral chamber. The diagnosis of a proliferative disease of the cerebellum was established and patient was referred to the Neurosurgical Department. Fortunately, before the operation the echocardiography was performed, which revealed two lesions in left atrium. The decision of the Heart Team was to refer the patient for an open-heart surgery, in which two thrombi were removed. Neurosurgeons decided to withdraw from further surgery and proceed with head MRI and conservative treatment, deciding that the lesion in the cerebellum was most likely an ischemic area.
  
  
  CONCLUSIONS
  Looking at the brain lesion should always be done from the whole patient's perspective. And using mutlimodality imaging may lead to appropriate diagnosis, correct course of therapeutic action and unexpected ending of a rather non-extraordinary case.
authors.affiliation: Department of Noninvasive Cardiology and Hypertension, Central Clinical Hospital of the Ministry of the Interior, Warsaw, Poland.
authors.forename: Olga
authors.initials: O
authors.lastname: Możeńska
authors.affiliation: Department of Noninvasive Cardiology and Hypertension, Central Clinical Hospital of the Ministry of the Interior, Warsaw, Poland.
authors.forename: Irena
authors.initials: I
authors.lastname: Kalińska
authors.affiliation: Department of Noninvasive Cardiology and Hypertension, Central Clinical Hospital of the Ministry of the Interior, Warsaw, Poland.
authors.forename: Karol
authors.initials: K
authors.lastname: Brodowski
authors.affiliation: Department of Radiology and Diagnostic Imaging, Medical Center of Postgraduate Education, Warsaw, Poland.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Walecki
authors.affiliation: Department of Noninvasive Cardiology and Hypertension, Central Clinical Hospital of the Ministry of the Interior, Warsaw, Poland ; Łazarski Uniwersity, Warsaw, Poland.
authors.forename: Dariusz A
authors.initials: DA
authors.lastname: Kosior
keywords: atrail fibrillation; cerebellum; multimodality imaging; thrombus