22514576 Visualization

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