Presentation
Dyspnea; suspected acute pulmonary embolism.
Patient Data
In the left atrial appendage, a windsock type, there are triangular and oval-shaped filling defects consistent with thrombus. There is no pulmonary embolism signs but is visible moderate bilateral pleural effusion with signs of interstitial pulmonary edema. In the abdomen there is also effusion around the liver and spleen.
Case Discussion
The left atrial appendage is the most common site for cardiac thrombus. It is anatomically attached to the left inferior portion of the left atrium and consists of muscular trabeculae. The left atrial appendage does not contribute, to a large degree, to overall cardiac output. CT is a very sensitive modality for detection of intracardiac thrombus. CT can result in false-positive findings such as circulatory stasis, which is also seen as a filling defect on CT images. A further assessment with delayed imaging of the LAA after 1 to 2 minutes can improve the specificity for distinguishing circulatory stasis from thrombus.
Case Courtesy: Dr.ssa Luisa Coletta