Spontaneous Left Atrial Dissection Presenting as Pulmonary Edema
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.