Key result
Urgent surgery enables prompt recovery in rare spontaneous left atrial intramural hematoma.
Case Report (n=1)
Multimodality imaging including echocardiography, CT, and CMR can accurately identify rare spontaneous left atrial intramural hematomas, which can be successfully managed with surgery.
Supports surgical resection for spontaneous left atrial intramural hematoma; leaves open standardized diagnostic and management strategies.
CASE SUMMARY: A 58-year-old man who had recently run a marathon and a 10-mile run was admitted with acute severe shortness of breath. Echocardiography showed a large left atrial mass. Cardiac magnetic resonance imaging showed intermediate signal intensity on T1-weighted images and slightly elevated signal on T2-weighted images. There was no enhancement of the mass on either first-pass or late-gadolinium enhancement images. The mass was considered to be very likely a spontaneous left atrial intramural hematoma (LAIH). The patient underwent surgery, where the diagnosis was confirmed. TAKE-HOME MESSAGES: LAIHs are mainly iatrogenic, caused by interventions such as mitral valve surgery, percutaneous coronary interventions, and radiofrequency catheter ablations. Spontaneous LAIH can be due to an underlying pathology, such as mitral annular calcification, mitral valve endocarditis, myocardial infarction, cardiac amyloidosis, or without an underlying pathology, such as in our case.
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Mulder et al. (2026) conducted a case report in Spontaneous left atrial intramural hematoma (n=1). Surgery was evaluated on Surgical confirmation and recovery. Urgent surgery confirmed the diagnosis of a rare spontaneous left atrial intramural hematoma and led to a speedy recovery with minimal remnant at 5 months.
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