Giant thrombus in the left atrium after radiofrequency catheter ablation for atrial fibrillation: A case report

Figures

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  Figure 1. Giant thrombi in the left atrium visualized by transthoracic and transesophageal echocardiography. A: Transthoracic echocardiography detected large, abnormal structures with beaded appearance in the left atrium (arrowhead). The left atrium was dilated, but the other findings were not significant. B: Transesophageal echocardiography revealed de novo pedunculated giant mobile masses, which were attached to the ostia of the left superior and right inferior pulmonary veins (arrowhead). The surfaces of these masses were partially collapsed. Thrombus in the left atrial appendage and spontaneous echo contrast were not detected. LSPV = left superior pulmonary vein.

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  Figure 2. Intraoperative images of the thrombus attached to the ostium of the left superior pulmonary vein (LSPV). The intraoperative photograph shows a cystic mass in the left atrium attached to the ostium of the LSPV. The other mass was observed near to the right inferior pulmonary vein, as transesophageal echocardiography was performed before surgery. These adhesion sites corresponded to the ablation scar. LAA = left atrial appendage.

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  Figure 3. Macroscopic and microscopic pathology images. A: Pathologic assessment revealed a cystic mass of 21 × 12 mm in size, which was attached to the left atrial roof near to the left superior pulmonary vein. B: Hematoxylin–eosin staining showed mixed thrombi consisting of fibrin and platelets, including infiltration of numerous neutrophils and histiocytes. No neoplastic cells or bacteria were observed.