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Cricket ball in the heart? Bullet-like thrombus or a thrombus-like mass in the left atrium
A fifty-year-old gentleman presented with dyspnoea of two weeks duration. He was hemodynamically stable. The electrocardiogram showed atrial fibrillation. Echocardiogram showed a huge spherical solid mass with a smooth surface in the left atrium. It moved freely back and forth hitting the mitral valve leaflets and also severe MS (Panel 1Ac; Supplementary material online, Videos S1 And S2). 3D ultrasound was not helpful in distinguishing the mass as thrombus or myxoma (Panel 2A). Surgical extraction of the mass and replacement of the mitral valve was performed. The extracted pink colored solid mass was 8.7.6 cm in size and weighed 106 grams. Section revealed whorled layers with a large cystic portion filled with blood (Panel 2B And c). On microscopy there was a central area of hemorrhage, alternating areas of fibrin and erythrocytes, and the presence of inflammatory cells on the outer surface of the mass (Panel 3Ac). Histopathology confirmed that the spherical solid mass was a giant ball valve thrombus.
Panel 1🙁A) The parasternal long axis of TTE shows a large round solid mass measuring 6.6 cm. (b) On the short axis, MVOA was 0.8 cm2. (c) On CW Doppler the mean MV Gr was 14 mmHg. Panel 2🙁A) 3D ultrasound showing the mass. (b) The solid spherical mass that measured 8.7.6 cm and weighed 106 grams. (c) The tortuous appearance of the mass on the cut section. Panel 3🙁A) Central bleeding area. (b) Alternative areas of fibrin and erythrocytes. (c) Inflammatory cells on the surface of the mass (haematoxylin-eosin stain, high power magnification).
Additional material is available at European Heart Journal online.
Articles from European Heart Journal are provided here courtesy of Oxford University Press
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Sources 2/ https://pmc.ncbi.nlm.nih.gov/articles/PMC4986032/ The mention sources can contact us to remove/changing this article |
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