Floating Mobile Mass That Is Probably Thrombus
A Life-Threatening Complication of Mitral Stenosis
A 52-year-old woman presented with palpitations, progressive shortness of breath, and transient dizziness during the week preceding this echocardiographic study. Physical examination was typical for mitral stenosis, with an irregular heart rate of 78 bpm, accentuated first heart sound, opening snap, and apical diastolic rumble. The ECG demonstrated atrial fibrillation. Two-dimensional (2D) echocardiographic images from the parasternal and apical positions are shown in the upper and lower panels of the Figure⇓ respectively, and an M-mode recording through the mitral valve and left atrium is also shown in the lower panel. The mitral leaflets were thickened and tethered, and there was a reduced E-F slope on the M-mode image, all consistent with rheumatic mitral stenosis. In addition, a left atrial mass was identified within the left atrium. This had no attachment site during systolic cycles (B) on 2D imaging. The mass floated freely within the left atrium. Floating thrombus constitutes a surgical emergency. The lethal potential of this floating thrombus was underscored by intermittent lodging in the mitral orifice during diastole (B on 2D images and fourth beat on M-mode image). Urgent surgery was recommended, but she declined for religious reasons. She died suddenly, 10 hours after the echocardiographic examination.
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 Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
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