Key result
Cardiac CT revealed that a suspected left atrial appendage thrombus seen on echocardiogram was actually an epicardial fat pad within the transverse sinus.
Why the study?
Accurate diagnosis of left atrial appendage thrombus is essential before cardioversion or catheter ablation, but anatomical variations of the left atrial appendage and surrounding structures can make diagnosis challenging.
Case Report (n=1)
Multimodality imaging, such as cardiac CT, can be essential to differentiate anatomical variations like an epicardial fat pad from a left atrial appendage thrombus when echocardiography is ambiguous.
Answers are grounded in this paper and cite their sources.
Multiple modalities may be needed for LAA thrombus diagnosis in AF with variants; leaves open standardized imaging algorithms.
The presence of left atrial thrombus is a contraindication to cardioversion or catheter ablation in patients with atrial fibrillation, due to the increased risk of systemic thromboembolism. Management of this situation includes changes in the anticoagulation regimen and repeat imaging tests. Accurate diagnosis of left atrial appendage thrombus is therefore essential but can sometimes be challenging. Multiple imaging modalities may sometimes be required in the setting of anatomical variations of the left atrial appendage and surrounding structures. We present the case of a patient awaiting ablation for atypical atrial flutter, who underwent a transthoracic echocardiogram that showed an echodense, mobile structure within the vicinity of the left atrial appendage, suggesting a possible thrombus. A cardiac CT demonstrated the image to correlate with an epicardial fat pad within the transverse sinus.
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Buttinger et al. (2021) conducted a case report in Atypical atrial flutter (n=1). Cardiac CT vs. Transthoracic echocardiogram was evaluated on Identification of the echodense structure. Cardiac CT revealed that a suspected left atrial appendage thrombus seen on echocardiogram was actually an epicardial fat pad within the transverse sinus.
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