A Pouch, a Ridge, and a Thrombus

Figures

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  Figure 1. Two-dimensional TTE, apical 4-chamber focused systolic view, demonstrates a pedunculated, left atrial mass (arrow) attached to the septum, resembling a myxoma.

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  Figure 2. Two-dimensional TEE, midesophageal bicaval (106°) (A) and short-axis (0°) (B) views, demonstrates the LASP (white arrow) containing the thrombus-like, echogenic mass (arrowhead) and thickening of the IAS in the region of the fossa ovalis, creating a stalk-like appearance consistent with the LASR (orange arrow).

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  Figure 3. Computed tomography angiography, dissection protocol with reconstruction of the aortoiliac system (A) and invasive angiography of the left femoral artery (B), demonstrates abrupt occlusion of the mid- left superficial femoral artery (SFA; white and black arrows) for approximately 19 cm with reconstitution of the distal left SFA (yellow arrow) and popliteal artery.

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  Figure 4. Two-dimensional TTE, apical-2-chamber systolic view, demonstrates the left atrial mass (white arrow) and a possible membrane (yellow arrow) extending anteroposteriorly in the LA.

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  Figure 5. Computed tomography angiography, dissection protocol, sagittal (A) and axial (B) views, demonstrates the IAS (straight arrows), the LASP with contained hypodense material within it (curved arrow) suggestive of thrombus, and the LASR (chevron). RA, Right atrium.

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  Figure 6. Three-dimensional TEE, midesophageal, simultaneous orthogonal, 2D long-axis (A) and short-axis (B) views and volume-rendered short-axis reconstruction from the atrial perspective (C) obtained 11 days after index presentation, demonstrates the LASP (yellow highlight) without contained echogenic mass, the LASR (orange arrows), and the IAS and LASP (chevron). AV, Aortic valve; RIPV, right inferior pulmonary vein; RSPV, right superior pulmonary vein; SVC, superior vena cava.

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  Figure 7. Schematic diagram depicting the embryology of left and right atrial septal pouches. PFO, Patent foramen ovale; RA, right atrium; RASP, right atrial septal pouch; SP, septum primum; SS, septum secundum.