J Cardiovasc Ultrasound.  2014 Dec;22(4):205-208. 10.4250/jcu.2014.22.4.205.

Left Atrial Intramural Hematoma after Removal of Atrial Myxoma: Cardiac Magnetic Resonance in the Differential Diagnosis of Intra-Cardiac Mass

• Lee HS
• Kim HK
• Park EA
• Kim KH
• Kim YJ
• Sohn DW

• KMID: 1980424
• DOI: http://doi.org/10.4250/jcu.2014.22.4.205

Abstract

Left atrial (LA) dissection is a rare entity, which is, in most cases, observed after valvular intervention. Transesophageal echocardiography (TEE) is considered to be a modality of choice in the diagnosis of LA dissection. However, LA dissection might be missed clinically in the absence of significant hemodynamic changes, and moreover physicians are occasionally reluctant to perform TEE due to its semi-invasiveness. Recently, cardiac magnetic resonance (CMR) has been introduced as a modality to perform different roles to existing imaging modalities, such as echocardiography. Given that CMR can provide information on tissue characteristics, it may give incremental information to TEE. We here present a rare case of LA dissection following LA myxoma removal, where CMR can make a correct diagnosis and guide management strategy.

Keyword

Left atrial dissection; Cardiac myxoma; Echocardiography; Cardiac magnetic resonance

MeSH Terms

Diagnosis
Diagnosis, Differential*
Echocardiography
Echocardiography, Transesophageal
Hematoma*
Hemodynamics
Myxoma*

Figure

• 

  Fig. 1 Echocardiography is a diagnostic tool of choice for left atrial dissection. Left atrium occupied by a newly developed mass (arrow) was found in parasternal long axis on postoperative day 4.

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  Fig. 2 Postoperative thoraco-abdominal computed tomography showed a large mass having 60 Hounsfield units (arrow), which was inconclusive because of ambiguous value of Hounsfield unit.

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  Fig. 3 Cardiac magnetic resonance performed on postoperative day 4 revealed that newly detected left atrial mass (arrow in A and B) was an intramural hematoma caused by left atrial dissection (A) showing no gadolinium enhancement (B), and heterogeneous intermediate signal intensity in T1- (C) and high T2- (D) weighted images.

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  Fig. 4 Follow-up transthoracic echocardiography on postoperative day 50 confirmed that the size of left atrial mass (arrow) was getting smaller.

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  Fig. 5 Left atrial intramural hematoma, followed by left atrial dissection, completely disappeared on follow-up cardiac magnetic resonance imaging 5 months after index surgery. A: Sagittal view. B: Transverse view.

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