A giant left atrial thrombus

Description

A 57-year-old woman with hypertension, dyslipidaemia, diabetes mellitus type 2, paroxysmal atrial fibrillation (AF), porcine mitral valve replacement and dilated cardiomyopathy requiring an automatic implantable cardioverter defibrillator presented with palpitation for 2 days. She had tiny left atrial thrombus (LAT), which resolved completely with warfarin 6 months ago. She was not in compliance with warfarin thereafter. Physical examination had no evidence for systemic embolisations and cardiovascular examination was unremarkable. ECG showed AF with rapid ventricular response of 132 beats per minutes. Chest X-ray showed remarkable cardiomegaly without congestion. Transthoracic echocardiogram (TTE) 6 months prior revealed a small LAT, normal bioprosthetic mitral valve and mild biventricular dilation with a severely reduced left ventricular ejection fraction of 25%–30%. Repeated TTE exposed a giant LAT measuring 4 cm x 3.5 cm (figure 1A–D, arrows). Surgical removal was recommended due to high risk of embolisation but patient deferred. Enoxaprin overlapping with warfarin was initiated and a rapid reduction in...

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