A free-floating left atrial mass.

摘要

A 78-year-old woman was transferred to our stroke unit 10 days after cerebral infarction. Her left hemisphere was affected, resulting in residual aphasia and mild right hemiparesis. Medical history included coronary artery bypass grafting 18 years before, and atrial fibrillation. Longstanding warfarin therapy had been temporarily suspended, and subcutaneous nadroparin initiated in advance of recent orthopaedic surgery. Two-dimensional and three-dimensional transoesophageal echocardiography (figure A, B; see also webvideo 1) showed a 6 cm diameter free-floating left atrial mass, suggesting embolisation was the cause of the stroke. The mass had no mural attachment and could not cross the mitral valve orifice (figure C; see also webvideo 2). Nadroparin was immediately switched to an intravenous unfractioned heparin infusion. Cardiac surgery was deferred until 15 days after stroke onset, during which time the heparin infusion was continued and intracranial haemorrhage was excluded by CT. At surgery, the mass was successfully removed and was consistent with a left atrial ball thrombus.