Demonstration of Inverted Left Atrial Appendage Using Cardiac Computed Tomography
An Unusual Complication Mimicking Left Atrial Mass After Cardiac Surgery
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An 18-year-old boy with aortic sinus dilatation, aortic regurgitation, and mitral regurgitation caused by cardiovascular involvement of the vasculitis was referred to our hospital for surgery. He underwent a Bentall operation and mitral valve replacement uneventfully. On preoperative echocardiography, left atrial appendage (LAA) appeared normal. There was no anatomic variation or abnormal mass in the left atrium seen on surgical inspection. Postoperative transesophageal echocardiography revealed a tongue-like, protruding mass in the left atrium cavity (Figure [A], and Movie I in the online only Data Supplement). The mass measured 17×13 mm and demonstrated mixed echogenicity with a low-echogenic outer layer and a central, high-echogenic portion. The mass was initially thought to be a thrombus mixed with a foreign body. ECG-gated cardiac computed tomography (CT) showed a lobulated, low-density, mass-like lesion in the left atrium, which arose from the anterolateral wall …