Left Atrial Thrombus Present: Is That about It?

Abstract

Two-dimensional echocardiography is extremely useful in detecting localized as well as floating intracardiac bodies. Transesophageal echocardiography (TEE) is highly sensitive in localizing intracardiac masses especially those present in the posterior structures of the heart, such as the left atrium (LA) and the left atrial appendage (LAA), which are extremely difficult to image using the transthoracic echocardiography. Dislodgement of intracardiac masses (thrombus, tumor) can be associated with high risk of life-threatening hemodynamic perturbations or embolic phenomenon. Cardiac manipulations should thus be minimized in patients with intracardiac masses. We discuss the case of LAA thrombus dislodgement during inferior vena cava cannulation. Intraoperative TEE demonstrated a fixed thrombus in the LAA, and despite careful attention by the surgeon, trivial cardiac manipulation during inferior vena cava cannulation leads to the dislodgment of the LAA thrombus and its free floatation in the LA. This case report highlights the crucial role of a vigilant TEE examination in patients with intracardiac thrombi. Identification of echocardiographic risk factors for prediction of dislodgement of LAA is of utmost importance to avoid inadvertent complications.