‘Bird-beak sign’ of left atrial thrombus: a guide to management

Singla, Vivek; Singh, Yadvinder; Ravindranath, S; Manjunath, Cholenahally Nanjappa

doi:10.1136/bcr-2013-010459

Cited by 2 publications

(2 citation statements)

References 2 publications

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“…TTE revealed a mild dilatation of LA with no contrast or intracavitary mass and normal left ventricular shape and contractility and moderate mitral regurgitation. TEE revealed LA with light spontaneous echocardiographic contrast (SEC), low ostial emptying velocities <40cm/sec ( Figure 1) and unilobar LAA with thrombus (2cm/1.5cm) (Figure 2) with echolucent center ("beard-beak sign of recent and growing thrombus") [3], protruding to LA during systole (Figure 3), few thin thoracic aorta plaques.He was discharged on acenocumarol therapy. …”

Section: First Casementioning

confidence: 99%

Echocardiography for assessment of left atrial stasis and thrombosis – three cases report

Tanasa¹,

Arhirii²,

Popa³

et al. 2015

Arch Clin Cases

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We report three cases of chronic atrial fibrillation without anticoagulation admitted for acute lower limb ischemia in which embolic source was left atrial appendage (LAA) thrombus revealed only by transesophageal echocardiography (TEE). Transthoracic echography (TTE) revealed left atrial dilatation (LA) with no contrast or intracavitary mass. TEE revealed LA with spontaneous echographic contrast, low ostial emptying velocities and congenital morphology of LAA with older and organized thrombus or with echolucent centre (" beard-beark sign of recent and growing thrombus") and thoracic aorta atheroma plaques. They were discharged on acenocumarol/ novel oral anticoagulant therapy. Two-dimensional echocardiography should be recommended in all patients with periprocedural acute peripheral embolism and TEE only in selected cases. Very high incidence of acute embolic ischemia is probably due to lack of preoperative anticoagulation more than to nontherapeutical anticoagulation (international normalized ratio INR<2).

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Section: First Casementioning

confidence: 99%

Echocardiography for assessment of left atrial stasis and thrombosis – three cases report

Tanasa¹,

Arhirii²,

Popa³

et al. 2015

Arch Clin Cases

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“…1 The cavitation is thought to reflect a rapidly growing thrombus. To the best of our knowledge, this is the first time a case of deep venous thrombosis and left atrial appendage thrombus has been described in the context of suspected heparin-induced thrombocytopenia.…”

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confidence: 99%

Cavitated Left Atrial Appendage Thrombus in Heparin-Induced Thrombocytopenia

Rao

Beauchesne

2014

Circulation

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A 75-year-old woman with a history of hypertension, rheumatoid arthritis, and nonvalvular atrial fibrillation (CHADS 2 score=2) treated with dabigatran presented to the hospital with a 5-day history of fever and malaise and 1 episode of bright red blood per rectum. The patient had recently finished a course of oral antibiotics for a urinary tract infection and reported no residual urinary symptoms. Physical examination revealed a blood pressure of 138/90 mm Hg, a heart rate of 162 bpm, and a temperature of 40.5°C. Her jugular venous pressure was flat with normal heart sounds, a soft apical systolic murmur. ECG demonstrated atrial fibrillation with rapid ventricular response and no significant ST-segment abnormalities. The patient was subsequently admitted to the general medicine service for fever, uncontrolled atrial fibrillation, and anemia.Dabigatran was held because of the gastrointestinal bleeding, and low-dose prophylactic subcutaneous heparin prophylaxis was initiated. The patient developed right lower-extremity swelling, and compression ultrasonography demonstrated an occlusive right proximal deep venous thrombosis. Persistent fever led to a transesophageal echocardiogram to rule out infective endocarditis. The transesophageal echocardiogram revealed normal biventricular function and a normal mitral valve with mild to moderate (2+) mitral regurgitation. A large 2.8×2.0-cm cavitated mass was seen in the left atrial appendage with an appearance consistent with thrombus (Figure and Movie I in the online-only Data supplement). No neurological sequelae or systemic emboli resulted, and the patient was initiated on low-molecular-weight heparin. Thrombocytopenia developed, with her platelet count decreasing from 317 to 67×10 9 /L over the course of 2 days. An ELISA assay for heparin-induced thrombocytopenia was positive, but a functional assay was negative. Fondaparinux was initiated, with recovery of the platelet count before discharge on rivaroxaban 20 mg daily 3 weeks after her admission.The cavitated morphology of the left atrial appendage thrombus has been described in a case report of a patient with rheumatic mitral stenosis and referred to as a "bird-beak" appearance. 1 The cavitation is thought to reflect a rapidly growing thrombus. To the best of our knowledge, this is the first time a case of deep venous thrombosis and left atrial appendage thrombus has been described in the context of suspected heparin-induced thrombocytopenia. DisclosuresNone.

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‘Bird-beak sign’ of left atrial thrombus: a guide to management

Cited by 2 publications

References 2 publications

Echocardiography for assessment of left atrial stasis and thrombosis – three cases report

Echocardiography for assessment of left atrial stasis and thrombosis – three cases report

Cavitated Left Atrial Appendage Thrombus in Heparin-Induced Thrombocytopenia

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