Key result
Spontaneous left atrial appendage inversion occurs without prior cardiac surgery, driven by trans-wall pressure gradients.
Why the study?
Inversion of the left atrial appendage is a rare, easily overlooked cause of a left atrial mass, and the spontaneous form occurring outside any surgical context is documented in fewer than ten cases worldwide.
Case Report (n=1)
This first autopsy case report and updated literature review highlights that spontaneous inversion of the left atrial appendage can present as a left atrial mass even in infants without prior cardiac surgery, typically triggered by a pressure gradient from pericardial effusion.
Spontaneous left atrial appendage inversion warrants inclusion in left atrial mass differentials; leaves open its prevalence and management.
BACKGROUND: A mass in the left atrium commands immediate attention. Echocardiography reflexively points towards thrombus, vegetation, or tumour-the common culprits. Rarer, and easily overlooked, is a fourth possibility that has accumulated a quiet but instructive literature since the earliest days of open-heart surgery: inversion of the left atrial appendage. The spontaneous form, occurring outside any surgical context, is documented in fewer than ten cases worldwide. CASE PRESENTATION: We present the autopsy findings of a spontaneously inverted left atrial appendage in an 8-month-old male infant who had never undergone cardiac surgery. CONCLUSION: This case, placed alongside an updated review of the literature from 2020 to 2024, reinforces a simple but easily forgotten message: spontaneous left atrial appendage inversion can occur at any age, even in infants with no surgical history. A pressure gradient across the appendage wall, most often driven by pericardial effusion, appears to be the decisive pathophysiological trigger.
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Wathek et al. (2026) conducted a case report in Spontaneous inversion of the left atrial appendage (n=1). Spontaneous left atrial appendage inversion occurred in 1 8-month-old male infant without prior cardiac surgery, driven by a trans-wall pressure gradient.
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