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(Circulation. 2003;108:2722.)
© 2003 American Heart Association, Inc.

Images in Cardiovascular Medicine

Giant Left Atrial Aneurysm in a 15-Month-Old Child

Andrew Sands, MB; Brian Edis, MD; Andrew Cochrane, MD

From the Department of Paediatric Cardiology, Royal Children’s Hospital, Melbourne, Australia.

Correspondence to Dr Andrew Sands, Specialist Registrar, Department of Pediatric Cardiology, Royal Belfast Hospital for Sick Children, 180 Falls Rd, Belfast, BT12 6BE, UK. E-mail andrewsands{at}tiscali.co.uk

A15-month-old boy with an 8-week history of breathing difficulty was brought to the accident and emergency department in atrial fibrillation. Clinical examination demonstrated moderate cardiac failure, and a chest radiograph showed gross enlargement of the mediastinal/cardiac silhouette (Figure 1). An echocardiogram showed an aneurysmal mass arising from the left atrium (Figure 2). The child was anticoagulated and given digoxin and frusemide. He unfortunately developed a mild right hemiparesis, presumably from a thromboembolic event. Two days later, a giant aneurysm of the left atrium was resected at surgery (Figure 3). A small portion of thrombus was removed from the appendage. Sinus rhythm resumed immediately, and the child made a good recovery. At the time of discharge, the hemiparesis had significantly improved.

View larger version (162K): [in this window] [in a new window]   Figure 1. Plain chest radiograph suggesting massive cardiac enlargement.

View larger version (103K): [in this window] [in a new window]   Figure 2. Echocardiogram in a subcostal, 4-chamber view. A giant left atrial aneurysm (LAA) is seen extending into the upper chest with the right and left ventricles below.

View larger version (115K): [in this window] [in a new window]   Figure 3. Surgical view after initial dissection. The patient’s head is to the left. The aneurysm is seen as a large, purplish mass occupying much of the mediastinum. A normal right ventricle lies inferiorly.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Sands, A. Articles by Cochrane, A. Search for Related Content PubMed PubMed Citation Articles by Sands, A. Articles by Cochrane, A. Related Collections Other heart failure CV surgery: other Pediatric and congenital heart disease, including cardiovascular surgery