Left Atrial Appendage Clot

 

Image Library Home >> Cardiac Thrombi >> Left Atrial Appendage Clot
  • Smoke in LAA, no clot
  • Mobile LAA Clot
  • Chronic, Large LAA clot
  • Post OHT LAA clot

The examples shown here will serve to highlight the different forms and views that left atrial appendage clot can take. It is important to be familiar with all of them.

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Clot in the atrial appendage needs to be assessed along many angles of omni with the transesophageal probe.

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In this case we see there is severe smoke but no clear thrombus at the initial view at and in this view at 76 degrees.

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Further views are shown here all confirming no thrombus, but predominantly dense smoke.

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Sometime perfluorocarbon based echo contrast can be used if the diagnosis is in doubt.

 

 

 

 

 

 

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This example shows a thrombus that is adherent to the LA appendage, surrounded by low flow conditions as evidenced by the "smoke" seen in the LA.

 

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This example shows a large calcified thrombus in the left atrial appendage that is unmistakable. Several different views are shown. Note the well defined borders and edges and the more echodense material, compared to the prior example.

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This thrombus is less mobile than the previous example and appears tethered but clearly puts the patient at high risk for stroke during cardioversion.

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Note the associated "smoke" signifying a low flow state in the left atrium, which in this individual was markedly enlarged.

 

 

 

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This individual is recently post cardiac transplant. On first glance this clot may be hard to see, because it fills the entirety of the left atrial appendage.

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However up on further views it is clear this is a clot with a significant mobile component extending outside of the LAA.

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Color Doppler also shows the small areas of flow in and out of the appendage through small crevices around the thrombus.