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European Heart Journal 1988 9(6):672-677;
Copyright © 1988 by the European Society of Cardiology.
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© 1988 The European Society of Cardiology

Left atrial ball thrombus: Echocardiographic features and clinical implications

A. G. FRASER, G. D. ANGELINI*, S. IKRAM and E. G. BUTCHART*

Departments of Cardiology University Hospital of Wales Heath Park Cardiff CF4 4XN, U.K.
*Departments of and Cardiothoracic Surgery, University Hospital of Wales Heath Park, Cardiff CF4 4XN, U.K.

Received 9 October 1987; .

Dr Alan G. Fraser. Senior Registrar in Cardiology, University Hospital of Wales, Heath Park, Cardiff CF4 4XN, U.K.

Abstract

The echocardiographic features of left atrial ball thrombus associated with mitral stenosis are reviewed, and some previously unpublished cross-sectional echocardiographic findings presented. In one patient who had a large free-floating ball thrombus there was variation in its echocardiographic appearance; the thrombus was removed uneventfully at surgery. In another patient who had a pedunculated but immobile ball thrombus, a stalk was identified which attached it to the inter-atrial septum; this patient died suddenly before surgery could be performed, due to detachment of the thrombus and obstruction of the mitral valve orifice. Cross-sectional echocardiography is clearly superior to M-mode imaging in the detection of atrial thrombi, and variable appearances mav help differentiation of thrombus from myxoma. Whether or not a ball thrombus appears mobile, emergency thrombectomy and mitral valve replacement is indicated, because of the risk of obstruction of the mitral valve.

Key Words: Mitral stenosis • ball thrombus • echocardiography


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