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

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

doi:10.1016/j.radcr.2020.07.050

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

Radiol Case Rep. 2020 Aug 18;15(10):1909-1914. doi: 10.1016/j.radcr.2020.07.050. eCollection 2020 Oct.

Authors

Negeen Shahandeh¹, Richard J Shemin², Justin P McWilliams³, John M Moriarty³, Ashley E Prosper⁴, Jonathan M Tobis¹

Affiliations

¹ 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.
² Department of Surgery, University of California Los Angeles, Los Angeles, CA, USA.
³ Division of Interventional Radiology, Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA.
⁴ Department of Radiological Sciences, Thoracic and Diagnostic Cardiovascular Imaging, University of California Los Angeles, Los Angeles, CA, USA.

Abstract

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.

Keywords: Cardiac CT; Cardiac MRI; Cardiac mass; Echocardiography; Hereditary hemorrhagic telangiectasia.

Publication types

Case Reports