Left atrial thrombus mimicking myxoma in a patient with hereditary hemorrhagic telangiectasia: Diagnostic and therapeutic dilemmas

Negeen Shahandeh, MD; Richard J. Shemin, MD; Justin P. McWilliams, MD; John M. Moriarty, MD; Ashley E. Prosper, MD; Jonathan M. Tobis, MD

Radiology Case Reports (Oct 2020)

Left atrial thrombus mimicking myxoma in a patient with hereditary hemorrhagic telangiectasia: Diagnostic and therapeutic dilemmas

Negeen Shahandeh, MD,
Richard J. Shemin, MD,
Justin P. McWilliams, MD,
John M. Moriarty, MD,
Ashley E. Prosper, MD,
Jonathan M. Tobis, MD

Affiliations

Negeen Shahandeh, MD: Division of Cardiology, Department of Medicine, University of California Los Angeles, 650 Charles E. Young Drive South, A2-237 CHS, Los Angeles, CA 90095, USA; Corresponding author.
Richard J. Shemin, MD: Department of Surgery, University of California Los Angeles, Los Angeles, CA, USA
Justin P. McWilliams, MD: Division of Interventional Radiology, Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA
John M. Moriarty, MD: Division of Interventional Radiology, Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA
Ashley E. Prosper, MD: Department of Radiological Sciences, Thoracic and Diagnostic Cardiovascular Imaging, University of California Los Angeles, Los Angeles, CA, USA
Jonathan M. Tobis, MD: Division of Cardiology, Department of Medicine, University of California Los Angeles, 650 Charles E. Young Drive South, A2-237 CHS, Los Angeles, CA 90095, USA

Journal volume & issue: Vol. 15, no. 10
pp. 1909 – 1914

Abstract

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Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disorder characterized by the development of arteriovenous malformations. The arteriovenous shunts may result in high output heart failure, which predisposes to atrial dilatation and atrial fibrillation. Due to recurrent bleeding from epistaxis or the gastrointestinal tract, patients with HHT and atrial fibrillation are at high risk of bleeding if anticoagulated for stroke prevention. In this report, we present a case of a 74-year-old woman with a history of HHT and atrial fibrillation who developed a large left atrial thrombus that initially was thought to represent an atrial myxoma. The diagnosis was confirmed with cardiac magnetic resonance imaging, and the patient underwent surgical resection of the thrombus. This case demonstrates the role of different imaging modalities in the assessment of left atrial masses and presents an opportunity to review the data on safety of anticoagulation in patients with HHT.

Published in Radiology Case Reports

ISSN: 1930-0433 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Medicine (General): Medical physics. Medical radiology. Nuclear medicine
Website: https://www.sciencedirect.com/journal/radiology-case-reports

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