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Cardiac
Intervention
Interventional and Electrophysiological Procedures
Left Atrial Thrombus
Left Atrial Thrombus
Jonathan Hero Chung, MD; Suhny Abbara, MD, FACR, FSCCT; Arzu Canan, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Thrombus formation in left atrial appendage (LAA) or in body of left atrium
              • Usually due to atrial fibrillation or mitral valve stenosis or other slow flow states

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  • Echocardiographic Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Consider

                                    Selected References

                                    1. Chen J et al: Cardiac MRI for detecting left atrial/left atrial appendage thrombus in patients with atrial fibrillation: meta-analysis and systematic review. Herz. ePub, 2018
                                    2. Korsholm K et al: Cardiac computed tomography for left atrial appendage occlusion: acquisition, analysis, advantages, and limitations. Interv Cardiol Clin. 7(2):229-42, 2018
                                    3. Turagam MK et al: Cardiovascular therapies targeting left atrial appendage. J Am Coll Cardiol. 72(4):448-63, 2018
                                    4. Kirchhof P et al: 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur J Cardiothorac Surg. 50(5):e1-e88, 2016
                                    5. Taina M et al: Cardiac CT differentiates left atrial appendage thrombi from circulatory stasis in acute stroke patients. In Vivo. 30(5):671-6, 2016
                                    6. Hong YJ et al: Dual-energy cardiac computed tomography for differentiating cardiac myxoma from thrombus. Int J Cardiovasc Imaging. 30 Suppl 2:121-8, 2014
                                    7. Motwani M et al: MR imaging of cardiac tumors and masses: a review of methods and clinical applications. Radiology. 268(1):26-43, 2013
                                    8. Balli O et al: Multidetector CT of left atrium. Eur J Radiol. 81(1):e37-46, 2012
                                    9. Hur J et al: Cardioembolic stroke: dual-energy cardiac CT for differentiation of left atrial appendage thrombus and circulatory stasis. Radiology. 263(3):688-95, 2012
                                    10. Daccarett M et al: MRI of the left atrium: predicting clinical outcomes in patients with atrial fibrillation. Expert Rev Cardiovasc Ther. 9(1):105-11, 2011
                                    11. Gorodnitskiy A et al: A novel approach to left atrial appendage exclusion: the WATCHMAN device. Cardiol Rev. 18(5):230-3, 2010
                                    12. Qamruddin S et al: Left atrial appendage: structure, function, imaging modalities and therapeutic options. Expert Rev Cardiovasc Ther. 8(1):65-75, 2010
                                    13. Kim YY et al: Left atrial appendage filling defects identified by multidetector computed tomography in patients undergoing radiofrequency pulmonary vein antral isolation: a comparison with transesophageal echocardiography. Am Heart J. 154(6):1199-205, 2007
                                    14. Hesse B et al: Images in cardiovascular medicine. A left atrial appendage thrombus mimicking atrial myxoma. Circulation. 113(11):e456-7, 2006
                                    15. Mohrs OK et al: Percutaneous left atrial appendage transcatheter occlusion (PLAATO): planning and follow-up using contrast-enhanced MRI. AJR Am J Roentgenol. 186(2):361-4, 2006
                                    16. Mohrs OK et al: Thrombus detection in the left atrial appendage using contrast-enhanced MRI: a pilot study. AJR Am J Roentgenol. 186(1):198-205, 2006
                                    17. Parekh A et al: Images in cardiovascular medicine. The case of a disappearing left atrial appendage thrombus: direct visualization of left atrial thrombus migration, captured by echocardiography, in a patient with atrial fibrillation, resulting in a stroke. Circulation. 114(13):e513-4, 2006
                                    18. Blackshear JL et al: Stroke prevention in atrial fibrillation: warfarin faces its challengers. Curr Cardiol Rep. 7(1):16-22, 2005
                                    19. Mutlu B et al: Fibrillatory wave amplitude as a marker of left atrial and left atrial appendage function, and a predictor of thromboembolic risk in patients with rheumatic mitral stenosis. Int J Cardiol. 91(2-3):179-86, 2003
                                    20. Nakai T et al: Percutaneous left atrial appendage occlusion (PLAATO) for preventing cardioembolism: first experience in canine model. Circulation. 105(18):2217-22, 2002
                                    21. von der Recke G et al: Transesophageal contrast echocardiography distinguishes a left atrial appendage thrombus from spontaneous echo contrast. Echocardiography. 19(4):343-4, 2002
                                    22. von der Recke G et al: Use of transesophageal contrast echocardiography for excluding left atrial appendage thrombi in patients with atrial fibrillation before cardioversion. J Am Soc Echocardiogr. 15(10 Pt 2):1256-61, 2002
                                    23. Sim EK et al: Co-existing left atrial thrombus and myxoma in mitral stenosis--a diagnostic challenge. Singapore Med J. 40(1):46-7, 1999
                                    24. Takeuchi M et al: Enhanced visualization of intravascular and left atrial appendage thrombus with the use of a thrombus-targeting ultrasonographic contrast agent (MRX-408A1): In vivo experimental echocardiographic studies. J Am Soc Echocardiogr. 12(12):1015-21, 1999
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Top Differential Diagnoses

                                          • Clinical Issues

                                            TERMINOLOGY

                                            • Definitions

                                              • Thrombus formation in left atrial appendage (LAA) or in body of left atrium
                                                • Usually due to atrial fibrillation or mitral valve stenosis or other slow flow states

                                            IMAGING

                                            • General Features

                                              • Radiographic Findings

                                                • CT Findings

                                                  • MR Findings

                                                    • Echocardiographic Findings

                                                      • Imaging Recommendations

                                                        DIFFERENTIAL DIAGNOSIS

                                                          PATHOLOGY

                                                          • General Features

                                                            CLINICAL ISSUES

                                                            • Presentation

                                                              • Demographics

                                                                • Natural History & Prognosis

                                                                  • Treatment

                                                                    DIAGNOSTIC CHECKLIST

                                                                    • Consider

                                                                      Selected References

                                                                      1. Chen J et al: Cardiac MRI for detecting left atrial/left atrial appendage thrombus in patients with atrial fibrillation: meta-analysis and systematic review. Herz. ePub, 2018
                                                                      2. Korsholm K et al: Cardiac computed tomography for left atrial appendage occlusion: acquisition, analysis, advantages, and limitations. Interv Cardiol Clin. 7(2):229-42, 2018
                                                                      3. Turagam MK et al: Cardiovascular therapies targeting left atrial appendage. J Am Coll Cardiol. 72(4):448-63, 2018
                                                                      4. Kirchhof P et al: 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur J Cardiothorac Surg. 50(5):e1-e88, 2016
                                                                      5. Taina M et al: Cardiac CT differentiates left atrial appendage thrombi from circulatory stasis in acute stroke patients. In Vivo. 30(5):671-6, 2016
                                                                      6. Hong YJ et al: Dual-energy cardiac computed tomography for differentiating cardiac myxoma from thrombus. Int J Cardiovasc Imaging. 30 Suppl 2:121-8, 2014
                                                                      7. Motwani M et al: MR imaging of cardiac tumors and masses: a review of methods and clinical applications. Radiology. 268(1):26-43, 2013
                                                                      8. Balli O et al: Multidetector CT of left atrium. Eur J Radiol. 81(1):e37-46, 2012
                                                                      9. Hur J et al: Cardioembolic stroke: dual-energy cardiac CT for differentiation of left atrial appendage thrombus and circulatory stasis. Radiology. 263(3):688-95, 2012
                                                                      10. Daccarett M et al: MRI of the left atrium: predicting clinical outcomes in patients with atrial fibrillation. Expert Rev Cardiovasc Ther. 9(1):105-11, 2011
                                                                      11. Gorodnitskiy A et al: A novel approach to left atrial appendage exclusion: the WATCHMAN device. Cardiol Rev. 18(5):230-3, 2010
                                                                      12. Qamruddin S et al: Left atrial appendage: structure, function, imaging modalities and therapeutic options. Expert Rev Cardiovasc Ther. 8(1):65-75, 2010
                                                                      13. Kim YY et al: Left atrial appendage filling defects identified by multidetector computed tomography in patients undergoing radiofrequency pulmonary vein antral isolation: a comparison with transesophageal echocardiography. Am Heart J. 154(6):1199-205, 2007
                                                                      14. Hesse B et al: Images in cardiovascular medicine. A left atrial appendage thrombus mimicking atrial myxoma. Circulation. 113(11):e456-7, 2006
                                                                      15. Mohrs OK et al: Percutaneous left atrial appendage transcatheter occlusion (PLAATO): planning and follow-up using contrast-enhanced MRI. AJR Am J Roentgenol. 186(2):361-4, 2006
                                                                      16. Mohrs OK et al: Thrombus detection in the left atrial appendage using contrast-enhanced MRI: a pilot study. AJR Am J Roentgenol. 186(1):198-205, 2006
                                                                      17. Parekh A et al: Images in cardiovascular medicine. The case of a disappearing left atrial appendage thrombus: direct visualization of left atrial thrombus migration, captured by echocardiography, in a patient with atrial fibrillation, resulting in a stroke. Circulation. 114(13):e513-4, 2006
                                                                      18. Blackshear JL et al: Stroke prevention in atrial fibrillation: warfarin faces its challengers. Curr Cardiol Rep. 7(1):16-22, 2005
                                                                      19. Mutlu B et al: Fibrillatory wave amplitude as a marker of left atrial and left atrial appendage function, and a predictor of thromboembolic risk in patients with rheumatic mitral stenosis. Int J Cardiol. 91(2-3):179-86, 2003
                                                                      20. Nakai T et al: Percutaneous left atrial appendage occlusion (PLAATO) for preventing cardioembolism: first experience in canine model. Circulation. 105(18):2217-22, 2002
                                                                      21. von der Recke G et al: Transesophageal contrast echocardiography distinguishes a left atrial appendage thrombus from spontaneous echo contrast. Echocardiography. 19(4):343-4, 2002
                                                                      22. von der Recke G et al: Use of transesophageal contrast echocardiography for excluding left atrial appendage thrombi in patients with atrial fibrillation before cardioversion. J Am Soc Echocardiogr. 15(10 Pt 2):1256-61, 2002
                                                                      23. Sim EK et al: Co-existing left atrial thrombus and myxoma in mitral stenosis--a diagnostic challenge. Singapore Med J. 40(1):46-7, 1999
                                                                      24. Takeuchi M et al: Enhanced visualization of intravascular and left atrial appendage thrombus with the use of a thrombus-targeting ultrasonographic contrast agent (MRX-408A1): In vivo experimental echocardiographic studies. J Am Soc Echocardiogr. 12(12):1015-21, 1999