Case images: Giant left atrial thrombus with atypical location

An 62 year-old woman was admitted to our hospital because of palpitation and dyspnea. Physical examination was unremarkable except for tachycardia. A 12-lead electrocardiogram showed atrial fibrillation. Transesophageal echocardiography (TEE) revealed a large suspicious mass (4x2 cm) between superior pulmonary vens, which could have been a cardiac metastatic mass protruding into the left atrium. There were no idendefiable masses in the left atrial appendage. Fractional heparin was started to prevent any tromboembolic occurrences during follow up. Two weeks later TEE revealed that the mass became smaller (3x1cm) and became mobile and fragile. The patient had cardiac surgery performed for the removal of the intracardiac mass. On pathologic examination the mass was diagnosed as an organized thrombus.
TTE has been shown to be a superior method in defining the characteristics of a mass in the left atrium. We think to metastatic cardiac mass that between superior pulmonary vens of mass and absence of any additional masses in the left atrial appendage in our case. However, we think to organized thrombus that smaller in mass with heparin theraphy.