Author + information
- Landai Nguyen,
- Sarina Sachdev,
- Hassan Tahir,
- Sajjad Ahmad,
- Farnoosh Rahimi,
- Christopher Malozzi and
- Bassam Omar
Pulmonary emboli (PTE) are often due to lower extremity (LE) deep vein thrombosis (DVT); other etiologies are possible but less likely.
36 yo female has dyspnea and right LE DVT. CT angio (CTA) revealed right lung PTE and right atrium (RA) shadow (Fig. 1A), thought to be artifact as it was not seen on transthoracic echo (TTE; Fig. 1B). Warfarin was started, but with recurrence of symptoms few weeks later. Re CTA revealed left-sided PTE and persistent RA shadow (Fig. 1C). Transesophageal echo (TEE) revealed multilobulated mass in the RA (Fig. 1D); later excised surgically (Fig. 1E). though to be myxoma given consistency, lobulation (Fig. 1F) and lack of response to warfarin. Pathology confirmed thrombus.
PTE was initially attributed to LE DVT. RA shadow on CTA was thought to be artifact, as it was not corroborated by TTE. PTE recurrence prompted TEE which confirmed RA mass, initially thought to be myxoma due to its shape and persistence despite anticoagulation. Pathology confirmed a thrombus. Patient was maintained on anticoagulation without recurrence.
Pursuing incidental findings on imaging is crucial even when obvious cause is available. Sensitivity of TEE is higher than TTE. Tissue diagnosis should be obtained as appearances are often deceiving.
Poster Hall, Hall F
Monday, March 18, 2019, 9:45 a.m.-10:30 a.m.
Session Title: FIT Clinical Decision Making: Non Invasive Imaging 5
Abstract Category: Non Invasive Imaging
Presentation Number: 1312-135
- 2019 American College of Cardiology Foundation