Unusual Case of a Free-floating Ball Thrombus with Preserved Attachment to the Left Atrial Appendage Causing Recurrent Obstruction of the Left Ventricular Outflow Tract.
Few cases of a left atrial thrombus without mitral valve disease have been reported. We present an unusual case in which a patient presented to the emergency department with syncope and acute cerebral ischemia caused by a ball thrombus originating from the left atrium (LA). An emergency bedside echocardiogram showed the LA ball thrombus intermittently obstructing the mitral orifice and, at times, compromising the left ventricular outflow tract. This thrombus was determined to be the source of cerebral embolization resulting in acute ischemia. Surgical excision of the mass was performed. At operation, the thrombus was found to be tethered to the left atrial appendage. This tethering was not apparent on the echocardiographic images, where the thrombus appeared to be free floating. This case demonstrates the utility of transthoracic echocardiography in establishing the etiology of emergent conditions seemingly unrelated to acute cardiac disease, in this situation a neurologic presentation with syncope and cerebral ischemia.
Department of Cardiology, Arnsberg Medical Center, Arnsberg, Germany.
Brunilda
B
Alushi
Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University Hospital Münster, Germany.
Andreas
A
Hoffmeier
Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University Hospital Münster, Germany.
Jürgen
J
Sindermann
Department of Cardiology, Arnsberg Medical Center, Arnsberg, Germany.
Dirk
D
Böse
Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC, USA.
J Lee
JL
Garvey
Department of Cardiology, Arnsberg Medical Center, Arnsberg, Germany.
Frank
F
Breuckmann
anticoagulation; atrial fibrillation; ball thrombus; surgical resection