Buttinger Nicolas, Dooley Maureen, McCready James, Julia Justo
Sussex Cardiac Centre, Brighton, United Kingdom.
Sussex Cardiac Centre, Brighton, United Kingdom.
Indian Pacing Electrophysiol J. 2021 May-Jun;21(3):174-177. doi: 10.1016/j.ipej.2021.02.006. Epub 2021 Feb 16.
The presence of left atrial thrombus is a contraindication to cardioversion or catheter ablation in patients with atrial fibrillation, due to the increased risk of systemic thromboembolism. Management of this situation includes changes in the anticoagulation regimen and repeat imaging tests. Accurate diagnosis of left atrial appendage thrombus is therefore essential but can sometimes be challenging. Multiple imaging modalities may sometimes be required in the setting of anatomical variations of the left atrial appendage and surrounding structures. We present the case of a patient awaiting ablation for atypical atrial flutter, who underwent a transthoracic echocardiogram that showed an echodense, mobile structure within the vicinity of the left atrial appendage, suggesting a possible thrombus. A cardiac CT demonstrated the image to correlate with an epicardial fat pad within the transverse sinus.
左心房血栓的存在是房颤患者进行心脏复律或导管消融的禁忌症，因为系统性血栓栓塞的风险会增加。这种情况的处理包括调整抗凝方案和重复进行影像学检查。因此，准确诊断左心耳血栓至关重要，但有时也具有挑战性。在左心耳及其周围结构存在解剖变异的情况下，有时可能需要多种影像学检查方法。我们报告一例等待非典型房扑消融治疗的患者，其经胸超声心动图显示左心耳附近有一个回声致密的活动结构，提示可能存在血栓。心脏CT显示该图像与横窦内的心外膜脂肪垫相符。
