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+A 70–year–old female presented to the Emergency Department with palpitations, dyspnea and anterior epistaxis.
+She had a 3 years history of atrial fibrillation and chronic heart failure NYHA class III.
+She was treated with aspirin 100 mg/day.
+Physical examination revealed an irregular pulse of 148 beats/min, blood pressure of 130/100 mmHg, pansystolic mitral murmur of 2/6 grade, murmur of tricuspid regurgitation of 3/6 grade, lower extremities swelling.
+The oto-rhino-laryngology exam conclusion was of anterior epistaxis.
+The 12–lead electrocardiogram revealed atrial fibrillation, inferior ischemia.
+Her International Normalized Ratio (INR) was of 1,24.
+The two–dimensional transthoracic echocardiography showed the thickening of the mitral valves with a moderate mitral insufficiency and a mobile round mass in the left atrium, heterogeneous, inhomogeneous, of 18 mm in size, attached with a narrow stalk to the interatrial septum.
+It showed a tumor–like movement with a cardiac cycle, reaching the mitral annular plane (Figure 1,Figure 2).
+Also, echocardiography showed tricuspid insufficiency with a maximum gradient of 30 mmHg, intact interatrial septum, akinesia of two thirds of basal inferior wall, ejection fraction of 42%.
+There was no mass in the left atrial appendage.
+The two–dimensional transesophageal echocardiography confirmed the presence of the intraatrial mass.
+Epistaxis was considered to be due to heart failure and the increased venous pressure.
+The patient was referred to the cardiovascular surgery clinic, but she refused surgery.
+Anticoagulation with fraxiparine of 0,6 ml/day was started and continued for 3 weeks, after cessation of epistaxis by nasal tamponament.
+After 3 weeks the echocardiography was repeated, with no remnant mass in the left atrium.
+The conclusion was that the mass must have been a thrombus that has melted away.
+In this particular case, the left intraatrial thrombus may have been due to the presence of atrial fibrillation.