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Canadian Journal of Cardiology

Mass in the Left Atrial Appendage: A Therapeutic Dilemma

Published:August 20, 2012DOI:https://doi.org/10.1016/j.cjca.2012.05.019

      Abstract

      This is a case of a persistent mobile mass in the left atrial appendage in which 3-dimensional transesophageal echocardiography provided excellent definition of the contour of the mass and helped in comparison during follow-up. The mass was incidentally found before atrial fibrillation ablation and initially thought to be a thrombus. As it persisted almost unchanged despite adequate anticoagulation, a tumour such as a fibroelastoma became the leading possibility, presenting us with a management dilemma. Ablation was cancelled, and, because the mass was stable with no embolic sequelae, a conservative approach was adopted. The patient was discharged on long-term anticoagulation.

      Résumé

      Il s'agit d'un cas de masse mobile persistante à l'appendice auriculaire gauche pour laquelle l'échocardiographie transœsophagienne 3D a produit une excellente définition du contour de la masse et a aidé à la comparaison durant le suivi. La masse a été découverte fortuitement avant l'ablation de la fibrillation auriculaire et semblait d'abord être un thrombus. Puisqu'elle demeurait presque inchangée en dépit d'une anticoagulation adéquate, une tumeur telle qu'un fibroélastome devenait la possibilité principale, représentant pour nous un dilemme de prise en charge. L'ablation a été annulée et, puisque la masse était stable et sans séquelles emboliques, une approche classique a été adoptée. Le patient dont une anticoagulation à long terme a été prescrite a obtenu son congé de l'hôpital.
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