Answer for BIR CoW 29 Apr 2018
Left Atrial thrombus
Findings
Findings: Pedunculated hypointense lesion is noted within the left atrial chamber and attached to the free wall. The lesion is inferior and posterior to the left main pulmonary artery. It measures 27 x 15 x 16 mm. The lesion appears hyperintense in short TI and hypointense with TI greater than 600. On contrast administration no significant enhancement is noted. No significant delayed hyperenhancement of the myocardium is also noted. Cine trufi imaging revealed no significant hypokinesia of the ventricles. PC flow study revealed reduced average velocity in the main pulmonary artery (5.9 cm/sec).
Discussion
Intracardiac masses in LA are rare Primary cardiac tumors occur 30 times less frequently than cardiac metastasis Most common benign tumors : Myxomas, lipomas Primary malignant tumor : Sarcomas LA thrombus is infrequently detected in presence of sinus rhythm Diagnosis of LA mass with thrombus is challenging LA thrombus is associated with atrial fibrillation, dilated left atrium, mitral stenosis, low ejection fraction, prosthetic mitral or tricuspid valves, hypertrophic cardiomyopathy or infective endocarditis Atrial thrombi with stalk may be mistaken for myxomas ECHO (TEE) – mainstay for thrombus detection Cardiac MRI – Non invasive, helpful in determining location and extent of cardiac masses, increased specificity for evaluation of tissue characteristics and to help differentiate tumor from thrombus. DIFFERENCES IN IMAGING FEATURES OF ATRIAL MYXOMA VS THROMBUS MYXOMA CT: Size - Larger Attenuation - Low Contrast enhancement - Heterogeneous Prolapse into ventricle - Yes Site - In/near fossa ovalis MRI : Solitary SSFP: Hyperintense Cine: may prolapse into Ventricles Heterogenous Contrast enhancement THROMBUS Size - Smaller Attenuation - High Contrast enhancement - Homogeneous Prolapse into ventricle - No Site - Posterolateral wall of atrium MRI : Layered Iso to Hypointense Akinetic No/ mild enhancement Hyperintense in short TI and hypointense with TI greater than 600
Findings
Findings: Pedunculated hypointense lesion is noted within the left atrial chamber and attached to the free wall. The lesion is inferior and posterior to the left main pulmonary artery. It measures 27 x 15 x 16 mm. The lesion appears hyperintense in short TI and hypointense with TI greater than 600. On contrast administration no significant enhancement is noted. No significant delayed hyperenhancement of the myocardium is also noted. Cine trufi imaging revealed no significant hypokinesia of the ventricles. PC flow study revealed reduced average velocity in the main pulmonary artery (5.9 cm/sec).
Discussion
Intracardiac masses in LA are rare Primary cardiac tumors occur 30 times less frequently than cardiac metastasis Most common benign tumors : Myxomas, lipomas Primary malignant tumor : Sarcomas LA thrombus is infrequently detected in presence of sinus rhythm Diagnosis of LA mass with thrombus is challenging LA thrombus is associated with atrial fibrillation, dilated left atrium, mitral stenosis, low ejection fraction, prosthetic mitral or tricuspid valves, hypertrophic cardiomyopathy or infective endocarditis Atrial thrombi with stalk may be mistaken for myxomas ECHO (TEE) – mainstay for thrombus detection Cardiac MRI – Non invasive, helpful in determining location and extent of cardiac masses, increased specificity for evaluation of tissue characteristics and to help differentiate tumor from thrombus. DIFFERENCES IN IMAGING FEATURES OF ATRIAL MYXOMA VS THROMBUS MYXOMA CT: Size - Larger Attenuation - Low Contrast enhancement - Heterogeneous Prolapse into ventricle - Yes Site - In/near fossa ovalis MRI : Solitary SSFP: Hyperintense Cine: may prolapse into Ventricles Heterogenous Contrast enhancement THROMBUS Size - Smaller Attenuation - High Contrast enhancement - Homogeneous Prolapse into ventricle - No Site - Posterolateral wall of atrium MRI : Layered Iso to Hypointense Akinetic No/ mild enhancement Hyperintense in short TI and hypointense with TI greater than 600
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!