Wandering large left atrial thrombus

Rheumatic heart disease (RHD) is still one of the common causes of heart disease in India. It is also the most common cause of mitral stenosis (MS). Nearly one in every five mitral stenosis presents with thrombi in the left atrium (LA), therefore it has remarkable therapeutic consequences. We report a case of mobile LA mass in middle aged women newly diagnosed with severe MS with RHD. On transthoracic echocardiography, a round mass was seen wandering freely in left atrial cavity like a ping pong ball but did not prolapse between mitral leaflets due to severe MS. Subsequently, the patient was referred for surgical treatment, keeping the possibility of left atrial myxoma in mind. Gross examination revealed smooth spherical mass along with layered left atrial thrombus, which was also confirmed by histopathological examination. Hence, we conclude that most thrombi are located in the LA appendage, but atrial appendage thrombus can get detached and become freely mobile and be found in the LA cavity as in the presented case. Due to risk of systemic embolization urgent surgical removal should be norm in such cases.