Spontaneous Left Atrial Dissection Presenting as Pulmonary Edema

Abstract

A healthy 30-year-old man who had not had any prior medical or surgical history presented to the emergency department with substernal pain for 2 days that was sharp and exacerbated by inspiration and recumbency. Chest radiograph ( Figure 1A) showed mild left atrial enlargement. The ECG showed normal findings. The next day, the patient complained of sudden onset of class 3 dyspnea and frothy blood-tinged sputum. Follow-up chest radiography showed increased interstitial pulmonary vascular markings with consolidation in the right lower lung field, suggestive of pulmonary edema ( Figure 1B). Transthoracic echocardiogram showed minimal pericardial effusion and a cystlike, thin-walled, space-occupying lesion in the left atrium, which was not connected with the true lumen of the left atrium by color Doppler interrogation and contrast agent injection (Figure 2). Contrast cardiac computed tomography revealed a large homogenous mass in the posterior wall of the left atrium with a severely compressed left atrial chamber, which extended along the pulmonary veins, with tight luminal narrowing of the low pulmonary veins ( Figure 3). The patient underwent emergency surgery, and the condition was diagnosed as spontaneous left atrial dissection with minimal hemopericardium. From the Departments of Cardiology

Left ventricular free wall perforation and left atrial dissection: unusual complication of radiofrequency catheter ablation for Wolf-Parkinson-White syndrome

“…Rarely, they occur spontaneously without any underlying conditions or procedures 5. RFCA is a relatively safe procedure, but has been known to be associated with some complications, including valvular injury, access site haematoma or injury, tamponade or perforation.…”

Left atrial dissection

“…The causes of LA dissection were thought to be postoperative shear forces against the tissue between the mitral and aortic prostheses and marked tissue fragility due to systemic sclerosis and steroid treatment [14]. Spontaneous occurrence was seen in 11 patients [60,[62][63][64][66][67][68][69], including 2 patients primarily diagnosed with amyloidosis [61,65] and 2 patients with mitral annular calcification, which could have been the origin of the dissection in the LA wall [59,68]. Detailed information is summarized in Table 1.…”

Atrial Dissection‐Like Appearance Caused by an Inferior Sinus Venosus Atrial Septal Defect with an Unroofed Defect

“…It is generally associated with mitral valve replacement, but other predisposing factors should be considered in pathogenesis. 1,2 Atrial dissection-like appearance has been also reported 3 ; however, atrial dissection might be considered as an important differential diagnosis. Inferior sinus venosus (SV)-type atrial septal defect (ASD) is a rare congenital cardiac deformity that occurs between the inferior vena cava and right atrium.…”

“…Left atrial dissection is defined as a gap from the mitral or tricuspid annular area into the interatrial septum. It is generally associated with mitral valve replacement, but other predisposing factors should be considered in pathogenesis . Atrial dissection‐like appearance has been also reported; however, atrial dissection might be considered as an important differential diagnosis.…”