A neovascularized left atrial mass associated to mitral stenosis

Abstract EN

The discovery on echocardiography, of a large left atrial mass obliges the clinician to perform a differential diagnosis including tumor versus thrombus.

a 43 years old man without any cardiac antecedent, reported dyspnea and palpitation since 10 months.

The cardiac auscultation revealed an irregular rhythm with diastolic murmur at the apex.

The electrocardiogram showed an atrial fibrillation.

The transthoracic echocardiography revealed a severe mitral stenosis with a left atrial huge mass, confirmed on transesophageal echocardiography.

After 4 weeks of an efficient anticoagulant treatment, the mass persisted on echocardiography.

So we decided to resect the mass and to achieve a mitral valve replacement.

The preoperative coronarography showed neovascularization among the mass and fistula from the circumflex artery.

A vascular tumor was suggested especially myxoma, but the histological exam concluded at an organized thrombus.

Conclusion: coronary neovascularization is a specific sign for left atrial thrombus in mitral stenosis, but surgery is the best option to comfirm diagnosis.