A 32-year-old female presented with a 6-month history of worsening non-productive chronic cough and palpitations on moderate exercise. Chest X‑ray showed an increased cardiothoracic ratio with a prominent left heart border. She underwent transthoracic echocardiography in which a large cystic structure with compressive effect on the left ventricle was identified (Fig. 1a). Further evaluation by transoesophageal echocardiography proved the structure to be a large left atrial appendage aneurysm (LAAA) (7.7 × 4.4 cm) with a 1 cm entrance to the atrial cavity (Fig. 1b). The patient underwent aneurysm resection under cardiopulmonary bypass. Fig. 1c shows the resected aneurysm, which had a very thin wall. The postoperative course was uneventful.
LAAA are rarely encountered and generally present with palpitations, chest pain, dyspnoea or thromboembolic events [1]. The chronic cough could have been caused by the mechanical airway compression by LAAA. Once diagnosed, surgery is warranted regardless of presence of symptoms.
References
Aryal MR, Hakim FA, Ghimire S, et al. Left atrial appendage aneurysm: a systematic review of 82 cases. Echocardiography. 2014;31:1312–8.
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M. Toufan, L. Pourafkari, A. Afrasiabi, M. Sohrabi and N.D. Nader declare that they have no competing interests.
Caption Electronic Supplementary Material
Apical four-chamber trans-thoracic echocardiogram showing the large cystic structure that is compressing on the left ventricle
Modified three-chamber transthoracic echocardiogram showing the distortion of the left ventricle contour by the cystic structure
Transoesophageal echocardiogram at 60 degrees midoesophageal level showing the left atrial appendage aneurysm
Transoesophageal echocardiogram at 60 degrees midoesophageal level showing the blood flow in the left atrial appendage aneurysm
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Toufan, M., Pourafkari, L., Afrasiabi, A. et al. Left atrial appendage aneurysm presenting with chronic cough. Neth Heart J 25, 526–527 (2017). https://doi.org/10.1007/s12471-017-1021-0
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DOI: https://doi.org/10.1007/s12471-017-1021-0