PMC4218898_01
Apical four-chamber view of a mass (~4 x 3.5 cm) in the left atrium without recognizable attachment to the left atrial appendage, atrial wall, or mitral leaflets (A). Note the recurrent dislocation through the mitral valve orifice (B).
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This mass did not appear to be attached to the LAA (Fig. 1A), atrial wall, or mitral leaflets. There was a rate-dependent dislocation of this mass to the mitral valve orifice (Fig. 1B) and, at times, into the left ventricle (LV).
Postoperative view of the ball-like parietal thrombus. Interestingly, while appearing to be free-floating in echocardiography, it was found to be attached to the left atrial appendage by a thin bridge.
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The primary operative finding was a spherical purple gelatinous mass measuring 4.5 x 4 cm, partially free floating in the LA, but attached to the LAA by a thin bridge (Fig. 2).
Parasternal long-axis view of the same patient at 6 months follow-up showing no residuals, at this time a mild mitral regurgitation beside the known enlargement of the left atrium.
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The patient was anticoagulated during this period, and no new thrombus formation was identified on repeat echocardiographic examination (Fig. 3).