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Open Access Case report

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

Dirk Bruegger1*, Sebastian Sadoni2, Mikhail Primaychenko2, Ralf Sodian2, Christoph Schmitz2, Bruno Reichart2 and Daniel Chappell1

Author Affiliations

1 Department of Anesthesiology, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377 Munich, Germany

2 Department of Cardiac Surgery, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377 Munich, Germany

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Journal of Cardiothoracic Surgery 2011, 6:50  doi:10.1186/1749-8090-6-50

Published: 13 April 2011

Abstract

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.