Left atrial thrombus mimicking myxoma in a patient with hereditary hemorrhagic telangiectasia: Diagnostic and therapeutic dilemmas

Figures

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  Fig. 1. Iliofemoral angiogram demonstrated embolization coils and ethylene vinyl alcohol copolymer (Onyx, Medtronic, Minneapolis, MN) within the right internal iliac artery and right gonadal vein at the site of the previously embolized pelvic AVM (white arrow).

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  Fig. 2. Transthoracic echocardiogram depicting left atrial mass (white arrow) in the parasternal long axis view. LA, left atrium; LV, left ventricle; RV, right ventricle; Ao, aorta.

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  Fig,. 3. Precontrast steady state free precession images were obtained on a Siemens 1.5 Tesla Avanto MRI scanner (Siemens Healthineers, Erlangan, Germany), with axial (A) and coronal (B) imaging demonstrating a 2.7 × 2.8 cm mass (white arrows) in the dilated left atrium, with a thin stalk to the anterosuperior intra-atrial septum.

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  Fig. 4. High resolution breath-held contrast enhanced MR angiogram in the arterial phase in (A) sagittal, (B) transverse and (C) coronal planes obtained on a Siemens 1.5Tesla Avanto MRI scanner (Siemens Healthineers, Erlangan, Germany), demonstrating the dominant 2.7 × 2.8 cm nonenhancing mass (solid white arrows) in the dilated left atrium, and the smaller lesion in the left atrial appendage (open white arrows).

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  Fig. 5. Intraoperative images of left atrial mass prior to (A) and after resection (B) revealing the attachment of the mass to the intra-atrial septum by a thin stalk.

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  Fig. 6. High resolution breath-held contrast enhanced MR angiogram in the arterial phase in (A) sagittal, (B) transverse and (C) coronal planes obtained on a Siemens 1.5 Tesla Avanto MRI scanner (Siemens Healthineers, Erlangan, Germany), demonstrating subtle early heterogeneous enhancement of a left atrial myxoma on early post-contrast imaging (white arrows).

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  Fig. 7. Precontrast horizontal long axis balanced SSFP image (A) demonstrates a smoothly marginated mass (white arrow) attached to the intra-atrial septum. 10-15 minute postcontrast magnitude inversion recovery sequence in the horizontal long axis plane at the same level (B) demonstrates heterogeneous enhancement of the left atrial mass, consistent with a myxoma. Both sequences taken on Siemens 1.5 Tesla Avanto MRI scanner (Siemens Healthineers, Erlangan, Germany).