Left Atrial Ball Thrombus

May 1, 2004
Nicholas James, MD
Nicholas James, MD

A 72-year-old man with a history of rheumatic heart disease presented with pulmonary congestion and syncope. Results of the cardiac examination suggested mitral stenosis and atrial fibrillation with a controlled ventricular response.

A 72-year-old man with a history of rheumatic heart disease presented with pulmonary congestion and syncope. Results of the cardiac examination suggested mitral stenosis and atrial fibrillation with a controlled ventricular response. Two-dimensional echocardiography revealed a large, free-floating ball thrombus (T) in the dilated left atrium and demonstrated rheumatic and severely stenotic mitral valve leaflets. Emergency surgery was successfully performed to remove the ball thrombus, which was 2.5 cm in diameter and had a liquefied center, and replace the mitral valve. The patient had an uneventful recovery. Nicholas James, MD, of Mineola, NY, notes that left atrial ball thrombus is a rare clinical syndrome that is usually associated with severe, long-standing rheumatic mitral stenosis. Peripheral and cerebral emboli are frequent complications. Syncope and congestive heart failure are also common. Sudden death occurs when the ball thrombus becomes incarcerated in the stenotic mitral orifice (“hole-in-one” thrombus). Two-dimensional echocardiography is diagnostic, and early surgical intervention is mandatory to prevent catastrophic consequences. FOR MORE INFORMATION:
Wrisley D, Giambartolomei A, Lee I, Brownlee W. Left atrial thrombus: review of clinical and echocardiographic manifestations with suggestions for management. Am Heart J. 1991;121:260-262.