Khan Arshan, Riasat Maria, Ehtesham Moiz, Brink Dominic, Rai Kelash, Haseeb Muhammad, Khan Warisha, Zein Rami
Internal Medicine, Ascension St. John Hospital, Detroit, USA.
Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, USA.
Cureus. 2022 Apr 18;14(4):e24241. doi: 10.7759/cureus.24241. eCollection 2022 Apr.
The incomplete fusion of the septum primum and septum secundum results in the formation of the left atrial septal pouch (LASP). The clinical significance of this entity is a matter of controversy; however, it may act as a nidus for thrombus formation. We report a case of a 57-year-old male who was brought to the hospital by his girlfriend due to his bizarre behavior and confusion for one day. The initial workup for his altered mental status did not yield a diagnosis. The patient was admitted for further workup, which included an MRI of the brain that showed numerous very small-sized foci of restricted diffusion involving bilateral cerebral and cerebellar hemispheres consistent with thromboembolic infarct. The patient did not receive a tissue plasminogen activator (TPA) as he was out of the window for TPA. Transthoracic echocardiogram (TTE) with bubble study did not show patent foramen ovale (PFO) or atrial septal defect (ASD). ECG and telemetry showed normal sinus rhythm and no atrial fibrillation. A transesophageal echocardiogram (TEE) was obtained to find the source of the thromboembolic stroke. TEE discovered a 22 x 8-mm cystic structure in the interatrial septum consistent with a LASP. We hypothesize that the LASP may be a risk factor for cryptogenic stroke. Further research is needed to determine the prevalence of atrial septal pouch (ASP) in the general population, its clinical significance, and guidelines for treatment implications.
原发隔与继发隔未完全融合导致左房隔袋（LASP）形成。该实体的临床意义存在争议；然而，它可能成为血栓形成的病灶。我们报告一例57岁男性，其女友因其怪异行为和意识模糊一天将其送至医院。对其精神状态改变的初步检查未得出诊断结果。患者入院进一步检查，包括脑部MRI，显示双侧大脑半球和小脑半球有许多非常小的扩散受限病灶，符合血栓栓塞性梗死。由于超出了使用组织纤溶酶原激活剂（TPA）的时间窗，该患者未接受TPA治疗。经胸超声心动图（TTE）加气泡试验未显示卵圆孔未闭（PFO）或房间隔缺损（ASD）。心电图和遥测显示窦性心律正常，无房颤。为寻找血栓栓塞性中风的来源，进行了经食管超声心动图（TEE）检查。TEE在房间隔发现一个22×8毫米的囊性结构，符合LASP。我们推测LASP可能是隐源性中风的一个危险因素。需要进一步研究以确定一般人群中房隔袋（ASP）的患病率、其临床意义以及治疗建议指南。
