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CARDIOVASCULAR FLASHLIGHT
Cardiovascular flashlight
doi:10.1093/eurheartj/ehw176 Online publish-ahead-of-print 30 May 2016
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Cricket ball in the heart? Ball-like thrombus or a thrombus-like mass in the left atrium Jayashree Kharge*, Natraj Setty, Nishanth Ravindranath, and Raghu Thagachagere Ramegowda Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
* Corresponding author. Email: [email protected]
Fifty-year-old gentleman presented with dyspnoea of 2 weeks duration. He was haemodynamically stable. Electrocardiogram revealed atrial fibrillation. Echocardiogram showed a huge spherical smooth-surfaced solid mass in the left atrium. It was moving freely bouncing to and fro striking the mitral leaflets and also severe MS (Panel 1A–C; Supplementary material online, Videos S1 and S2). 3D echo was not helpful in differentiating the mass to be thrombus or myxoma (Panel 2A). Surgical extraction of the mass and mitral valve replacement was done. The extracted pink coloured solid mass measured 8 × 7 × 6 cm and weighed 106 gm. Cut section revealed whorled layers with a large cystic portion filled with blood (Panel 2B and C ). On microscopy there was a central area of haemorrhage, alternate areas of fibrin and erythrocytes, and the presence of inflammatory cells on the external surface of the mass (Panel 3A –C ). The histopathology confirmed the spherical solid mass to be a giant ball valve thrombus. Panel 1: (A) TTE parasternal long axis shows a large round solid mass measuring 6 × 6 cm. (B) In short axis, MVOA was 0.8 cm2. (C) On CW-Doppler the mean MV Gr was 14 mmHg. Panel 2: (A) 3D echo showing the mass. (B) The solid spherical mass that measured 8 × 7 × 6 cm and weighed 106 gm. (C) The whorled appearance of the mass on cut section. Panel 3: (A) Central area of haemorrhage. (B) Alternate areas of fibrin and erythrocytes. (C) Inflammatory cells on the surface of the mass (Haematoxylin-Eosin stain, high-power magnification). Supplementary material is available at European Heart Journal online. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2016. For permissions please email: [email protected].
CARDIOVASCULAR FLASHLIGHT
Cardiovascular flashlight
doi:10.1093/eurheartj/ehw176 Online publish-ahead-of-print 30 May 2016
.............................................................................................................................................................................
Cricket ball in the heart? Ball-like thrombus or a thrombus-like mass in the left atrium Jayashree Kharge*, Natraj Setty, Nishanth Ravindranath, and Raghu Thagachagere Ramegowda Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
* Corresponding author. Email: [email protected]
Fifty-year-old gentleman presented with dyspnoea of 2 weeks duration. He was haemodynamically stable. Electrocardiogram revealed atrial fibrillation. Echocardiogram showed a huge spherical smooth-surfaced solid mass in the left atrium. It was moving freely bouncing to and fro striking the mitral leaflets and also severe MS (Panel 1A–C; Supplementary material online, Videos S1 and S2). 3D echo was not helpful in differentiating the mass to be thrombus or myxoma (Panel 2A). Surgical extraction of the mass and mitral valve replacement was done. The extracted pink coloured solid mass measured 8 × 7 × 6 cm and weighed 106 gm. Cut section revealed whorled layers with a large cystic portion filled with blood (Panel 2B and C ). On microscopy there was a central area of haemorrhage, alternate areas of fibrin and erythrocytes, and the presence of inflammatory cells on the external surface of the mass (Panel 3A –C ). The histopathology confirmed the spherical solid mass to be a giant ball valve thrombus. Panel 1: (A) TTE parasternal long axis shows a large round solid mass measuring 6 × 6 cm. (B) In short axis, MVOA was 0.8 cm2. (C) On CW-Doppler the mean MV Gr was 14 mmHg. Panel 2: (A) 3D echo showing the mass. (B) The solid spherical mass that measured 8 × 7 × 6 cm and weighed 106 gm. (C) The whorled appearance of the mass on cut section. Panel 3: (A) Central area of haemorrhage. (B) Alternate areas of fibrin and erythrocytes. (C) Inflammatory cells on the surface of the mass (Haematoxylin-Eosin stain, high-power magnification). Supplementary material is available at European Heart Journal online. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2016. For permissions please email: [email protected].
