, Volume 39, Issue 7, pp 871–873 | Cite as

Massive thrombus originating from the interatrial septum and prolapsing into the left ventricle

  • A. AvciEmail author
  • A. Koç
  • D. Köprülü
  • M. Ürkmez
  • E. Alizade
  • G. Acar
  • T. Kırış
e-Herz: Case study

Atrial fibrillation (AF) results in loss of mechanical contraction of the left atrium (LA) leading to slow flow velocities in the LA and left atrial appendix, which ends with thrombus formation and risk of systemic embolism [1]. Thrombus inside the left atrial cavity is usually localized in the appendix, while a ball-shaped thrombus generally originates from the interatrial septum [2, 3]. A ball thrombus in the left atrium was first reported by Wood in 1814 at the autopsy of a 15-year-old girl with mitral stenosis [4]. A ball-shaped thrombus is extremely rare in the absence of mitral valve disease and was first described in 1992 [2, 5, 6]. A ball-shaped thrombus carries a high risk of systemic embolism and because it does not respond to anticoagulation in the acute phase, surgical thrombectomy is the first line of treatment, making this condition clinically important [7].

Case report

An 88-year-old woman with a history of hypertension and chronic AF on antiplatelet therapy (ticlopidine...


Left Atrium Left Anterior Descend Infective Endocarditis Right Coronary Artery Systemic Embolism 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Massiver Thrombus mit Ursprung im Vorhofseptum und Prolaps in den linken Ventrikel


Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

Supplementary material

Video 1: Apical three chamber view of the echocardiogram showing huge mobile thrombus in the left atrium. (AVI 2,3MB)

Video 2: Apical four chamber view of the echocardiogram showing huge mobile thrombus in the left atrium. (AVI 1.7MB)


  1. 1.
    Marcu CB, Kramer C, Donohue TJ (2007) Giant left atrial thrombus successfully treated with anticoagulation. Heart Lung Circ 16(1):55–56PubMedCrossRefGoogle Scholar
  2. 2.
    Kakkavas AT, Fosteris MK, Stougiannos PN et al (2011) A giant, free-floating mass in the left atrium in a patient with atrial fibrillation. Hellenic J Cardiol 52(5):462–465PubMedGoogle Scholar
  3. 3.
    Vitale M, Agnino A, Serena D et al (1997) Asymptomatic large left-atrial ball thrombus. Secondary to mitral stenosis. Tex Heart Inst J 24(4):376–378PubMedCentralPubMedGoogle Scholar
  4. 4.
    Kuo CT, Chiang CW, Lee YS et al (1992) Left atrial ball thrombus in nonrheumatic atrial fibrillation diagnosed by transesophageal echocardiography. Am Heart J 123(5):1394–1397PubMedCrossRefGoogle Scholar
  5. 5.
    Wrisley D, Giambartolomei A, Lee I, Brownlee W (1991) Left atrial ball thrombus: review of clinical and echocardiographic manifestations with suggestions for management. Am Heart J 121(6 Pt 1):1784–1790PubMedCrossRefGoogle Scholar
  6. 6.
    Yoshida K, Fujii G, Suzuki S et al (2002) A report of a surgical case of left atrial free floating ball thrombus in the absence of mitral valve disease. Ann Thorac Cardiovasc Surg 8(5):316–318PubMedGoogle Scholar
  7. 7.
    Teskin O, Bicer Y, Kaya U, Cicek S (2010) Left atrial thrombus following bilobectomy: a case report. J Med Case Rep 4:71PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Calé R, Andrade MJ, Lima S et al (2008) Giant left atrial mass: thrombus mimicking myxoma. Rev Port Cardiol 27(9):1191–1194PubMedGoogle Scholar
  9. 9.
    Dedeilias P, Roussakis A, Koletsis EN et al (2008) Left atrial giant thrombus infected by Escherichia Coli. Case report. J Cardiothorac Surg 3:18. doi:10.1186/1749-8090-3-18PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Lip GY, Lowe GD (1996) ABC of atrial fibrillation. Antithrombotic treatment for atrial fibrillation. BMJ 312(7022):45–49PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Lip GY (1995) Does atrial fibrillation confer a hypercoagulable state? Lancet 346(8986):1313–1314PubMedCrossRefGoogle Scholar
  12. 12.
    Alam M, Sun I (1991) Transesophageal echocardiographic evaluation of left atrial mass lesions. J Am Soc Echocardiogr 4(4):323–330PubMedCrossRefGoogle Scholar
  13. 13.
    Papadopoulos CH, Michalakeas CA, Paraskevaidis I et al (2010) Differential diagnosis of a left atrial mass: role of three-dimensional transoesophageal echocardiography. Hellenic J Cardiol 51(6):546–548PubMedGoogle Scholar
  14. 14.
    Lee CH, Chen CC, Chern MS (2007) Thrombolytic therapy for acute left atrial thrombus formation in one patient with heart failure and atrial fibrillation. Circ J 71(4):604–607PubMedCrossRefGoogle Scholar
  15. 15.
    Srimannarayana J, Varma RS, Satheesh S et al (2003) Prevalence of left atrial thrombus in rheumatic mitral stenosis with atrial fibrillation and its response to anticoagulation: a transesophageal echocardiographic study. Indian Heart J 55(4):358–361PubMedGoogle Scholar

Copyright information

© Urban & Vogel 2014

Authors and Affiliations

  • A. Avci
    • 1
    Email author
  • A. Koç
    • 2
  • D. Köprülü
    • 3
  • M. Ürkmez
    • 2
  • E. Alizade
    • 1
  • G. Acar
    • 1
  • T. Kırış
    • 3
  1. 1.Cardiology ClinicKartal-Koşuyolu Heart Education and Research HospitalIstanbulTurkey
  2. 2.Cardiovasculary Surgery ClinicOrdu State HospitalOrduTurkey
  3. 3.Cardiology ClinicOrdu State HospitalOrduTurkey

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