Atrial Intramural Hematoma Research Articles

Conservative treatment of a left atrial intramural hematoma after left atrial thrombus resection and concomitant mitral valve replacement - case report

Left atrial intramural hematoma is a seldom cause of left atrial mass. It has been described to occur spontaneously, after interventional procedures, after blunt chest trauma, or after aortocoronary bypass surgery. We present a case of mitral valve replacement together with the removal of a large intraatrial space-occupying lesion. Intraoperative transesophageal echocardiography confirmed a successful resection of this mass. Surprisingly, upon admission to ICU, transesophageal and transthoracic echocardiography revealed a recurrence of an intramural lesion, closest matching a hematoma, which was confirmed by contrast-enhanced computed tomography. Surgical intervention was thoroughly discussed but a conservative management was favoured. 3 months after surgery, a reassessed transthoracic echocardiography and computed tomography demonstrated an almost complete resolution of the pre-existing hematoma.

Left Atrial Intramural Hematoma after Resection of Myxoma: Report of a Case

A 73-year-old woman was referred for treatment of left atrial (LA) myxoma. At surgery, a myxoma was attached to the left atrial side of the fossa ovalis in the atrial septum by a stalk and was transmurally excised with a margin of the atrial septum. The atrial septum was closed without any prosthetic materials under mild to moderate tension. Although she was asymptomatic, postoperative transesophageal echocardiography (TEE) revealed an abnormal cavity, containing heterogeneous echogenesity without blood flow, in the posterior LA wall. Magnetic resonance imaging (MRI) demonstrated a mass without significant enhancement. It was considered to be an intramural hematoma, and the diagnosis of LA dissection was made. Follow-up echocardiography showed disappearance of the dissected lumen without surgical intervention. Both TEE and MRI are useful for the correct diagnosis of an LA dissection; and surgical intervention, entry closure or internal drainage, may not always be necessary in the absence of a hemodynamic compromise with an LA dissection.

A fast-growing obstructive left atrial intramural hematoma causing acute prolonged chest pain

A 74-year-old woman was at the emergency department for acute chest pain, dyspnea and severe transient hypotension. History was arterial hypertension and external electrical cardioversion (EEC) for persistent atrial fibrillation (AF) 8 days before admission. At that time echocardiography was normal. The patient underwent coronary angiography with no evidence of significant coronary arteries disease. At echocardiography a large multi-loculated mass occupying most of the left atrial space and obstructing left ventricular inflow was evident. There was mild pericardial effusion. The patient was operated and a large thrombus totally encompassed in the left atrial wall was removed. Initial tearing into the pericardial space was revealed. Post-surgical follow-up was uneventful and at 3-6 months normalization of the atrial cavity with blending of atrial endocardium and epicardium was demonstrated. No apparent etiological factor was found. We have provided evidence of the possible rapid formation of a large intramural atrial hematoma. Spontaneous atrial wall dissection should be considered in the differential diagnosis of chest pain.

Left atrial intramural hematoma after percutaneous coronary intervention

We described a complication during percutaneous coronary intervention. A bleeding into the left atrial wall occurred after stenting of the right coronary artery. Echocardiography revealed the diagnosis of a left atrial intramural hematoma. Conservative treatment was performed. After 4 weeks the hematoma resolved completely. Left atrial intramural hematoma as a complication after percutaneous coronary intervention has not been reported in the literature yet.

Right atrial wall hematoma following percutaneous mitral valvuloplasty

A 50-year-old male underwent successful percutaneous mitral valvuloplasty for restenosis after surgical commissurotomy. Trans-septal puncture was difficult. Following the procedure, the patient developed chest pain and signs of systemic venous congestion, yet no hemodynamic collapse. Echocardiographic evaluation revealed a cystic mass compressing the right atrium, not communicating with the atrial cavity, mostly an intramural hematoma. The case was managed conservatively, and serial echocardiographic follow-up showed gradual reduction in size until ultimate disappearance of the mass 1 month later. In conclusion, right atrial intramural hematoma is a possible complication of mitral valvuloplasty, readily detected by echocardiography, and amenable for conservative management.

Right Atrial Intramural Hematoma Associated with Aortic Dissection

A 75-year-old male presented with shortness of breath and abdominal pain; he had undergone coronary artery bypass graft surgery three months ago and had a history of coronary artery disease, hypertension, and end-stage renal disease. Transthoracic echocardiogram showed a right atrial mass. A computed axial tomography scan showed an atrial mass and type A aortic dissection. The patient sustained cardiorespiratory arrest and died. An autopsy showed an 8 cm atrial intramural hematoma originating from a dissecting aneurysm. This is the first case of right atrial intramural hematoma associated with aortic dissection exhibiting high mortality. Early diagnosis using multiple imaging modalities including magnetic resonance imaging and timely surgical intervention may improve survival. Intramural hematomas should be considered in patients presenting with right-sided cardiac lesions.

Intramural Atrial Hematoma After Catheter Ablation for Atrial Tachyarrhythmias

A 50-year-old woman with a 10-year history of recurrent atrial tachyarrhythmias consisting of atrial fibrillation and typical/atypical atrial flutter underwent radiofrequency ablation. She underwent electrical isolation of all 4 pulmonary veins for treatment of the atrial fibrillation, and then cavotricuspid ablation for typical right-sided atrial flutter. We noted that one of the atrial flutters had originated from the coronary sinus; thus, ablation was attempted within the coronary sinus to electrically isolate it. After the procedure, the patient was noted to be hypotensive. Transthoracic echocardiography revealed a large pericardial effusion with obliteration of the right ventricle and tamponade physiology (Figure 1A and Movie I). She underwent successful pericardiocentesis, and an …

Spontaneous Left Atrial Dissection and Hematoma Mimicking a Cardiac Tumor

A 59-year-old woman with no history of cardiac surgery or thoracic trauma presented to the emergency department with tachycardia and dyspnea. The ECG showed sinus rhythm (110 bpm). X-rays showed interstitial pulmonary edema. Transthoracic echocardiography revealed a mild enlargement of the left atrium (LA), normal left ventricular function, and a large fixed mass occupying almost entirely the LA and arriving just near the posterior mitral annulus. Moderate mitral regurgitation was present. Transesophageal echocardiography confirmed the presence of an inhomogeneous cyst-like mass with a thin hyperechogenic wall coming from …

Left Atrial Wall Hematoma After Radiofrequency Ablation for Atrial Fibrillation

3Department of Cardiology, Lions Gate Hospital, Vancouver, BC, Canada. trial fibrillation, the most common cardiac arrhythmia and an important cause of stroke, is increasingly being managed with radiofrequency ablation of the pulmonary vein ostia because many ectopic beats originate at this site. Radiologists viewing images after ablation may identify complications such as pulmonary vein stenosis. We report a case of left atrial intramural hematoma after radiofrequency ablation.

A Case of Spontaneous Left Atrial Intramural Hematoma Causing Vaso-occlusive Cardiogenic Shock

A Case of Spontaneous Left Atrial Intramural Hematoma Causing Vaso-occlusive Cardiogenic Shock

Spontaneous Intramural Atrial Hematoma Presenting as a Left Atrial Mass

We describe an unusual case of spontaneously occurring intramural atrial hematoma with no communication with either atrium. The diagnosis of left atrial mass was made from transthoracic echocardiography. Subsequent examination with transesophageal echocardiography confirmed a large mass essentially filling the whole left atrium but failed to provide an etiologic diagnosis, which was eventually made at surgery. (J Am Soc Echocardiogr 1999;12:1101-3.)