An interesting case of normal variant misinterpreted as left atrial mass

Abstract

Coumadin ridge is a normal anatomical variant that is found in the left atrium (LA). We present a case of a LA mass in a 69-year-old patient, diagnosed during preoperative evaluation for total knee replacement and hence referred for surgical resection of the atrial mass. Detailed and meticulous transthoracic and transesophageal echocardiographic examination revealed it as a prominent Coumadin ridge between the left superior pulmonary vein and LA appendage with a bulbous tip, confused initially as an LA mass. The echocardiographic appearance of Coumadin ridge is described as “Q-tip sign.” It can be differentiated with other structures, such as thrombus/atrial mass, because of its property of being at a specific location, lack of mobility, and unique linear structure with a rounded bulbous tip. This case highlights the importance of proper knowledge and the need for careful evaluation of normal structural variants to avoid unnecessary workup and treatment.