CME INDIA Case Presentation by Dr Deepak Gupta, DM Card, Pulse Hospital, Ranchi.

CME INDIA Case Study

What is this? RHD Post BMV long back. Sunus Rhythm. No fever.

CME INDIA Discussion:

Dr Vivek Gupta, Surat: LA Thrombus…

Dr Sandeep: Mobile LA thrombus sir??

Dr S K Goenka, Physician, Begusarai:? Ball valve thrombus.

Dr N K Singh: Ball valve thrombus.

Dr Satish Kumar, Cardiologist, Bokaro: Also, seems to be in AF. It has to be a clot. But?? Pedunculated or the same clot from LA migrating and getting entangled in the chordae. “Thrombus in-transit,” a rare event to record.

Dr Deepak Gupta, DM Card, Pulse Hosp, Ranchi: Pt getting recurrent TIA. It is moving to and fro from LA to LV and back to LA.

Dr Satish, Bokaro: Has a stalk?

Dr N K Singh: You point to myxoma? How u differentiate amongst Vegetation, Myxoma & Clot?

Dr Deepak Gupta, DM Card, Pulse Hosp, Ranchi: Not entangled in Chordeae. It is freely moving… LA to LV to LA. Movement is like vegetation or myxoma.

Dr P G Sarkar, DM Card, RIMS, Ranchi: Thrombus in transit. Specific term used for free floating thrombus in LA or RA.

Dr Bhanu Pratap Singh, Physician, Siwan, Bihar: Vegetation? This shadow is a bit fluffy and less organized (c.f.thrombus), and freely mobile ,so to me looks like vegetation. Other signs of infective endocarditis should be sought.

Dr Deepak Gupta, DM Card, Pulse Hosp, Ranchi: Whatever it is, Pt need urgent Surgery to remove it. Biopsy will give final result. Although movement is like vegetation but No fever. Myxoma in underlying Rheumatic valve -unlikely. Strong Possibility of clot is there, but very unusual movement…

CME INDIA Learning Points:

  • Myxomas typically appear as a mobile mass attached to the endocardial surface by a stalk, usually arising from the fossa ovalis. Myxomas with this appearance can be confidently diagnosed by echocardiography and further imaging is not necessary. If the narrow stalk is not visible, the diagnosis cannot be made by echocardiography and require further imaging, including magnetic resonance imaging (MRI) or CT. The classic triad found in patients with cardiac myxoma is characterized by obstruction of blood flow, constitutional symptoms and thromboembolic events.
  • Transoesophageal echocardiography imaging provides detailed information of a mobile mass in the left atrium. TTE is still a reliable tool in the diagnosis of large mobile atrial thrombi; TEE may help to differentiate clot from atrial myxoma.

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