Giant Left Atrial Appendage Aneurysm

date : 05.02.2012

Violeta Groudeva
Vesela Stoinova
Klavdia Patrikova

Imaging diagnostic department, Saint Ekaterina Hospital, Sofia 1431

violetagroudeva@gmail.com

Keywords: left atrial appendage aneurysm, cardio CT

Clinical history: We present a case of an young, 37 years old female patient referred to our clinic with complains of intermitten palpitations for several years. During the last months the complains were more frequent. The physical exam showed good general condition, the patient was tachycardic. The ECG revealed atrial fibrillations. The laboratory values were within normal ranges. Unremarkable past medical history

Imaging findings:

The chest X-ray revealed prominent upper left heart border. The patient underwent echocardiography which found left atrial mass toward the lateral wall of the atrium adjacent to the pericardium. The patient was referred for a CT exam for further assessment. Cardiac CT was performed with 320 slices Aquillion ONE Toshiba machine. The scan parameters included volume scan with prospective ECG triggering. Contrast enhancement was obtained with 60ml of contrast media with velocity of 5ml/sec. The slice thickness was 0,5mm with an interval of 0,25mm. We visualized a giant aneurysm of the left atrial appendage measuring 60 x 48 x 50 mm. There was a filling defect in the aneurysm indicative of thrombosis. There were no signs of left ventricule compression. The pericardium was intact. We found no significant coronary arteries stenoses and the valves were intact.

Final diagnosis: Left atrial appendage aneurysm

Discussion:

Left atrial appendage aneurisms are extremely rare. In the literature we found about 50 cases reported worldwhile. Aneurysmal left atrial appendage dilatation may be congenital or acquired. Congenital cases in turn can be intrapericardial with intact surrounding pericardium, and extrapericardial type in combination with a pericardial defect and herniation of the appendage within the defect. The acquired forms are associated with general atrial enlargement secondary to mitral valve disease. Despite the congenital origin clinical manifestation before the 2nd- 3rd decade is rare. The most common clinical presentation is that of supraventricular arrhythmias. Most patients however are assymptomatic. Complications are related to systemic thrombembolism Echocardiography usually reveals the diagnosis. CT and MRI help in the differential diagnosis and the presurgical planning. The recommended treatment for left atrial appendage aneurysms is surgical resection in order to avoid supraventricular arrhythmias and systemic thrombembolism

Differential diagnosis:

Diagnosis of left atrial appendage is easily confirmed with CT and is not a diagnostic problem. Differential diagnosis at initial evaluation with conventional Xray or echocardiography includes perycardial cyst, congenital pericardial defect, mitral valve pathology.

Take home messages:

MDCT is an extremely effective diagnostic method for left atrial appendage aneurysm. CT provides detailed information about the cardiac anatomy and morphology, visualizes thrombi in the aneurysm and help in the preoperative planning.

Bibliography:

1.Smeglin A., Merchan J., Johnstone M., Pastore J., Giant Left Atrial Appendage, Circulation 2008, 118, 2393-2394 2.Pome G., Pelenghi S., Grassi M., Vignati G., Pellegrini A., Congenital Intrapericardial Aneurysm of the Left Atrial Appendage, Ann Thorac Surg 2000, 69, 1569-1571 3.Munarriz A., Escribano E., Uchaga A., Olaz F., Beunza M., De la Fuente A., Cantabrana S., Sola T., Congenital Aneurysm of the Left Atrial Appendage, Eur J Echocardiogr 2008, 9 (1), 152- 154 4.Mathur A., Zehr K., Sinak L., Rea R., Left Atrial Appendage Aneurysm, Ann Thorac Surg 2005, 79, 1392-1393 5.Kiaii B., Doll N., Kuohl M., Mohl F., Minimal Invasive Endoscopic Resection of a Giant Left Atrial Appendage Aneurysm, Ann Thorac Surg 2004, 77, 1437-1438

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