Case report
A 74-year-old woman with a history of atrial fibrillation and
hypertension presented to our emergency department for persistent chest
tightness. One month ago coronary computed tomography angiography showed
mild coronary stenosis (Panels A). Electrocardiogram showed atrial
fibrillation, ST-T segment changes, and abnormal Q waves in leads III
and aVF(Panels B). Computed tomography showed multiple lacunar cerebral
infarction, heart enlargement and pericardial effusion(Panels C,D).
Transthoracic echocardiography showed an oval mass, 38*30mm in size,
moving fast in the left atrium like a ping-pong ball (Panels E、F and G;
Supplementary material online, Movie S1). Doppler echocardiography
showed that the mass blocked the mitral valve orifice during diastole.
No colour Doppler signal was detected in the mass (Panel H). Due to the
history of atrial fibrillation, this mass was diagnosed as a thrombus
and anticoagulation was administered with low molecular weight
heparin1,2. After 7 days, echocardiography
reexamination showed that the mass was still moving fast in the left
atrium as before. Due to the poor tolerance of the patient and the
patient’s refusal for surgical treatment, the patient was discharged
with anticoagulant therapy and followed up. Two months later, the
patient was readmitted with limb weakness and slurred speech, computed
tomography showed cerebral infarction in the right frontotemporal
lobe(Fig. 1F), echocardiography showed that the mass in the left atrium
had disappeared. Medication was ineffective and the patient died three
months later.