Keimyung Med J.  2015 Dec;34(2):133-140. 10.0000/kmj.2015.34.2.133.

A Case of Left Atrial Free-Floating Thrombus

• Kim DK
• Kim JS
• Yi HR
• Choi IZ
• Ahn HS
• Cho WH

• KMID: 2224176
• DOI: http://doi.org/10.0000/kmj.2015.34.2.133

Abstract

A 74-year-old woman who had paroxysmal atrial fibrillation without mitral stenosis was hospitalized for syncope and right-sided weakness. Echocardiography revealed a large free-floating thrombus in the left atrium, sometimes prolapsing partially into the left ventricle in diastole. Because of her poor neurological status, she was managed with anticoagulation. On the 12th day, the thrombus had disappeared on the follow-up echocardiography, and aortoiliac embolization was later detected on computed tomography. Unfortunately, she developed various complications of stroke and limb infarction, and died after 4 months of hospital care. In addition to this case report, we reviewed a total 70 cases of left atrial free-floating thrombus. Atrial fibrillation and mitral pathology were two major causative factors. All the cases, except 1, were confirmed on echocardiography. The most common presentation that led to echocardiography was systemic embolization, followed by heart failure. Others were acute hemodynamic decompensation from mitral obstruction, chest pain, palpitation, and bacteremia. Cardiac thrombectomy was the preferred treatment modality with favorable outcomes.

Keyword

Echocardiography; Free floating; Left atrium; Thrombus

MeSH Terms

Aged
Atrial Fibrillation
Bacteremia
Chest Pain
Diastole
Echocardiography
Extremities
Female
Follow-Up Studies
Heart Atria
Heart Failure
Heart Ventricles
Hemodynamics
Humans
Infarction
Mitral Valve Stenosis
Pathology
Stroke
Syncope
Thrombectomy
Thrombosis*