Case presentationWael Tantawy, MD

Cardiologist KFMMCwktantawy@gmail.com23 may 2013

history67 y old saudi female.K/C of HTN, AF on warfarinC/OPresented in her regular F/U with the primary care clinic complaining of SOB & LL edema.

Referred to cardiology clinic & echocardiography was requested.

Differential DiagnosisLA mass most probably LA myxoma. (abnormal attachment)

LA thrombus. (abnormal place)

Lipoma.Liomyosarcoma.Metastasis from the lung.

What is the next step?2- Further investigation.1- Course of anticoagulation.

3- Call the surgeon

Does the PFO change the decision?

Continue oral anticoagulation.

F/U echo after 2 weeks.The patient came back after 2 week.She was compliant to her ttt with INR 2.3.TTE was done for F/U

What are the possibilities ?Liomyosarcoma.

Bleeding inside myxoma.

Metastatics 2ndry to lung Tr

Enlarged thrombus

What is the next step? 1- Continue anticoagulation.2- Further investigation.

3-Call the surgeon.

The increase in mass size despite adequate dose of anticoagulation increase the suspicion of TUMER.

Due to the site of the mass & its encroachment on the Rt upper PV orifices. We elected to do further investigation.

CT Scan chest.

TEE also done for better visualization of the mass attachment

CT chest

TEE

What is the site of attachment of such mass?

What is the next step?1- Continue anticoagulation.2- Further investigation.3- Call the surgeon.