Question of the week


Your clinical case challenge by Andreas Bugge Tinggaard et al, Aarhus University Hospital, Aarhus, Denmark.

A 57-year-old male was hospitalised with an ischemic stroke verified on MRI. ECG showed AF. Echocardiography revealed a structurally normal heart. The patient was discharged with dabigatran. Another MRI-verified stroke led to re-hospitalisation 19 days later. Transesophageal echocardiography excluded intracardiac thrombi. Dabigatran was substituted with warfarin and the patient was referred for transcatheter left atrial appendage occlusion.

What does the CT show?

 



Answer is: Absence of the LAA caused by chronic thrombotic occlusion and epithelialization of the orifice.

The CT shows no contrast filling of the LAA. Multiplanar CT images revealed contours of a LAA and 3D-TEE confirmed LAA absence with a smooth-walled surface covering the orifice.