Left Juxtaposition of the Right Atrial Appendage: Pitfalls in Diagnosis

Figures

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  Figure 1. Initial chest CT, coronal view demonstrates what was believed to be a dissection flap (arrow) extending superiorly from the level of the anterior cusp of the aorta.

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  Figure 2. 2D TTE, suprasternal view demonstrates a dilated ascending aorta (Ao) and what was thought to be an intimal dissection flap (white arrows). RPA: right pulmonary artery.

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  Figure 3. Repeat chest CT, coronal (a) and axial (b) views demonstrate a dilated ascending aorta (21.8 mm; Boston Z-score 2.84) and a suspected intimal dissection flap extending anteriorly off of the anterior cusp (thin arrow) just above the sinotubular junction. For comparison, the normal anatomic location for the RAA is highlighted (open arrow).

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  Figure 4. Noncontrast CMR obtained in axial (a–c), sagittal (d), and coronal views (e). Sequential imaging obtained in 3D Heart Navigator Sequence during systole of the aortic root was performed moving from more cephalad to more caudad. The aortic root is intact, and there is no evidence of aneurysm as suspected on CCT. Instead, the arrows in each image highlight the unusual course of the RAA anteriorly around the root of the aorta extending to the left side and account for the suspected intimal flap previously noted.

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  Figure 5. (a, b) 2D TTE, subcostal window, coronal view demonstrates the LJRAA (thin arrow) to the left of the aorta and the normally positioned LAA.