Delange Segura L
Servicio de Anestesiología y Reanimación, Sección de Anestesia Cardiovascular, Hospital Regional Universitario Carlos Haya, Málaga.
Rev Esp Anestesiol Reanim. 2005 Aug-Sep;52(7):421-4.
A 72-year-old man who had been treated for 20 years with warfarin for auricular fibrillation was scheduled for resection of a sessile mass (3.5 x 4 cm) on the posterior wall of the left atrium and a smaller mass (1.5 x 2 cm) in the right atrium. The masses were diagnosed by transthoracic ultrasonography and computed tomography. After anesthetic induction, a tube was inserted for transesophageal ultrasound guidance during resection of the masses. During surgery, the presence of a large mass was confirmed on the posterior wall of the left atrium, which was enlarged due to chronic fibrillation. The smaller, mobile, pediculated mass attached to the right free wall of the atrium or to the tricuspid valve was also confirmed. Given these findings and the patient's history, differential diagnosis with either biatrial myxoma or thrombus was considered. After opening both atria, an organized thrombus in the left atrium and a large hypertrophic trabecula in the trabeculated portion of the right atrium was found to be responsible for the misleading ultrasonographic image suggesting masses.
一名因心房颤动接受华法林治疗20年的72岁男性，计划切除左心房后壁的一个无蒂肿块（3.5×4厘米）和右心房的一个较小肿块（1.5×2厘米）。这些肿块通过经胸超声心动图和计算机断层扫描诊断。麻醉诱导后，在肿块切除期间插入一根管子用于经食管超声引导。手术过程中，证实左心房后壁存在一个大肿块，由于慢性颤动而增大。还证实了附着于心房右游离壁或三尖瓣的较小、可移动、有蒂的肿块。鉴于这些发现和患者的病史，考虑与双房黏液瘤或血栓进行鉴别诊断。打开两个心房后，发现左心房内有一个机化血栓，右心房小梁化部分有一个大的肥厚小梁，这导致了提示肿块的误导性超声图像。
