Circulation. 2005;111:e372-e373
doi: 10.1161/CIRCULATIONAHA.104.477463
(Circulation. 2005;111:e372-e373.)
© 2005 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Spontaneous Left Atrial Dissection Presenting as Pulmonary Edema
Jung-Hyun Choi, MD;
Jun-Kyu Kang, MD;
Kyung-Joo Park, MD;
Jo-Won Jung, MD;
So-Yeon Choi, MD;
Myeong-Ho Yoon, MD;
Gyo-Seung Hwang, MD;
Seung-Jea Tahk, MD;
Joon-Han Shin, MD
From the Departments of Cardiology (J.-H.C., J.-W.J., S.-Y.C., M.-H.Y., G.-S.H., S.-J.T., J.-H.S.), Cardiac Surgery (J.-K.K.), and Radiology (K.-J.P.), Ajou University Hospital, Suwon, Republic of Korea.
Correspondence to Joon-Han Shin, Ajou University Hospital, San 5, Wonchon-dong, Yeongtong-gu Suwon, Republic of Korea 443-721. E-mail shin-jh{at}ajou.ac.kr
Ahealthy 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 ef- fusion 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.
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Figure 1. A, Initial chest radiograph showed bulging contour of left mid heart border (arrow), suggestive of left atrial enlargement with normal pattern of pulmonary vascularity. B, Chest radiograph taken 1 day later shows diffusely increased interstitial densities with septal lines and air-space consolidation predominantly in right lower lung zone.
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Figure 2. Transthoracic echocardiography showed abnormal membrane in left atrium (A, white arrowheads) with minimal pericardial effusion (black arrow). Background echo contrast of both sides in left atrium were nearly same. Color Doppler (B) and contrast echocardiography (C) revealed no communication of blood flow across membrane.
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Figure 3. Axial (A) and sagittal reformatted (B) CT images show large mass in posterior part of left atrial wall with smooth surface and homogenous density without enhancement by contrast media. Note tight narrowing of both inferior pulmonary veins (arrows) and compressed left atrial chamber.
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Circulation 2005 111: 2865.
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