The mass was surgically excised from the LAA through a right anterolateral thoracotomy. However, definite diagnosis was not possible because it was too small (10 × 5 mm) ( Fig. When TEE showed no regression of the mass after one month, cardiac magnetic resonance (CMR) was performed to determine whether the mass was thrombus or a tumor. The patient was discharged from the hospital with instructions to take warfarin (target international normalized ratio, 2–3) and undergo serial TEE for 6 months. The presumptive diagnosis was LAA thrombus. A TEE showed an 8 × 9-mm free-floating mass in the LAA ( Fig. Electrocardiography at admission and 6-day adhesive-patch electrocardiography revealed continuous sinus rhythm. His late presentation after symptom onset was outside the therapeutic window for thrombolysis or endovascular intervention, so he was prescribed 100 mg/d of aspirin. The patient's medical history included hypertension, type 2 diabetes, and hyperlipoproteinemia. Computed tomograms revealed ischemic stroke caused by occlusion of the left middle cerebral artery. Through 4 years of postoperative follow-up, he had no stroke symptoms.Ī 58-year-old man presented at our stroke unit 10 hours after the gradual onset of right-sided hemiplegia and dysarthria. After an uneventful 8-day hospital stay, the patient was discharged with instructions to take warfarin for 3 months. Histopathologic analysis of both masses revealed PFE ( Fig. Because occult atrial fibrillation was possible, we occluded the LAA. During surgical excision, a second mass (size, 5 mm) was discovered and excised ( Fig. We suspected myxoma or another growth, so surgery was indicated. We placed the patient on intravenous unfractionated heparin (target partial thromboplastin time, 50 s) for 23 days however, TEEs at 1 and 2 weeks after therapy had begun showed no shrinkage of the mass. A transesophageal echocardiogram (TEE) revealed a 13.5 × 12.7-mm mass attached to the ridge in the left atrium (LA) between the LAA and left upper pulmonary vein ( Fig. ![]() Intravenous thrombolysis substantially resolved his symptoms. ![]() A 75-year-old man was admitted for stroke that affected the left middle cerebral artery and caused right-sided hemiparesis.
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