Key result
The modified apical 4-chamber view on transthoracic echocardiography helps differentiate the Coumadin Ridge (fold of Marshall) from a left atrial appendage thrombus in dilated left atria.
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Highlights the diagnostic pitfall of misidentifying the Coumadin Ridge as a left atrial appendage thrombus during initial transthoracic echocardiography in patients with dilated left atria, and discusses the value of the modified apical 4-chamber view.
We read the study by Walczewski et al. The authors used the LATTEE registry to evaluate left atrial appendage (LAA) thrombus predictors. They call for comprehensive echocardiographic evaluation. We agree. Their analysis covers both sexes. Building on this, we highlight a shared diagnostic pitfall. The issue arises during the initial transthoracic echocardiography (TTE). Clinicians can misidentify the "Coumadin Ridge" (fold of Marshall) as a thrombus. This anatomical illusion affects men and women alike. It happens primarily in dilated left atria.
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Muhammed Emre Güleşir (2026) conducted a letter in Dilated left atria and suspected left atrial appendage thrombus. Modified apical 4-chamber view during transthoracic echocardiography (TTE) was evaluated. The modified apical 4-chamber view on transthoracic echocardiography helps differentiate the Coumadin Ridge (fold of Marshall) from a left atrial appendage thrombus in dilated left atria.
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