Publish in this journal
Journal Information
Vol. 67. Issue 12.
Pages 1054 (December 2014)
Download PDF
More article options
Vol. 67. Issue 12.
Pages 1054 (December 2014)
Image in cardiology
DOI: 10.1016/j.rec.2014.02.018
Full text access
Dislodgement and Embolization of a Left Atrial Appendage Thrombus
Desprendimiento y embolización de trombo de orejuela izquierda
Ignacio Hernández González, Miguel Ángel Navas Lobato
Corresponding author

Corresponding author:
, Jerónimo Farré Muncharaz
Servicio de Cardiología, Hospital Universitario Fundación Jiménez Díaz, IDC Salud, Universidad Autónoma de Madrid, Madrid, Spain
Article information
Full Text
Download PDF
Figures (1)
Additional material (3)
Full Text

An 80-year-old man was admitted to our center because of recurrent ischemic strokes. Notably, the patient had recently been diagnosed with adenocarcinoma of the lung and was waiting to start radiation therapy. In addition, he was receiving chronic anticoagulation therapy with a coumarin derivative for permanent atrial fibrillation and maintained adequate international normalized ratio (INR) control.

We performed a transesophageal study to evaluate the sources of embolism. The image, a 2-chamber view of the mid-esophagus and its orthogonal projection, obtained simultaneously by a 3-dimensional probe (Figure A, Video 1 of the supplementary material), showed a thrombus (10mm×8mm) attached to the atrial appendage wall. During the procedure, we observed the precise moment when the thrombus became detached from its anchorage on the atrial appendage wall and its mobilization (Figures B and C, Video 2 of the supplementary material). Following the disappearance of the thrombus, the pectinate muscles were identified only at the level of the tip of the atrial appendage pouch (Figure D, Video 3 of the supplementary material). During the study, there were no changes in rhythm, which remained in atrial fibrillation. The patient had a splenic infarction, confirmed by computed tomography.


Thrombus formation in the left atrial appendage can occur in individuals with lung cancer, despite adequate anticoagulation with vitamin K antagonists. The findings in our patient led to a change in the anticoagulant therapy, and anticoagulation with low-molecular-weight heparin was initiated.

Appendix A


Copyright © 2014. Sociedad Española de Cardiología
Revista Española de Cardiología (English Edition)

Subscribe to our newsletter

Article options
Supplemental materials
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?