The Coumadin Ridge: An Important Example of a Left Atrial Pseudotumour demonstrated by Cardiovascular Magnetic Resonance Imaging

Abstract

A coumadin ridge is an occasionally observed, but seldom described structure seen in the left atrium during cardiac magnetic resonance (CMR) imaging. In this case, the coumadin ridge was particularly prominent and could easily have been mistaken for a tumour or thrombus. Using the combined assessment from different CMR pulse sequences, we were able to correctly identify it as the coumadin ridge. We make the reader aware of the location and the CMR imaging features of this structure so that misdiagnosis may be avoided.

Keywords: Coumadin ridge; cardiac magnetic resonance; pseudotumours.

Figure 1

50 year old female with a prominent coumadin ridge. The study was performed using a 1.5 Tesla scanner (Inter CV, Philips, Best, The Netherlands). The CMR signals were received by a 5-element cardiac phased -array coil and ECG gating. This is a systolic frame of a multi-phase balanced SSFP cine (Echo time (TE) 1.7ms, Repetition time (TR) 3.5ms, flip angle 60 degrees, SENSE factor 2, matrix 192 × 192, field of view 320–460mm, slice thickness 6mm, 24 phases per cardiac cycle, 1 slice per breath-hold) acquired in a modified double oblique orientation demonstrating the incidental mass-like structure (arrow) in the left atrium (LA).

Figure 2

In this 50 year old female with a prominent coumadin ridge, a customised axial view using a multi-phase balanced SSFP cine sequence (TE 1.7ms, TR 3.5ms, flip angle 60 degrees, SENSE factor 2, matrix 192 × 192, field of view 320–460mm, slice thickness 6mm, 24 phases per cardiac cycle, 1 slice per breath-hold) demonstrates the close proximity of the structure to the left upper pulmonary vein (LUPV).

Figure 3

50 year old female with a prominent coumadin ridge. This ECG-gated breath-hold T1-weighted (TR msec/TE msec = 800/38) axial view demonstrates the signal characteristics of the ridge to be similar to adjacent myocardium on T1-weighted imaging.

Figure 4

50 year old female with a prominent coumadin ridge. The coumadin ridge is also of similar signal intensity to adjacent myocardium on T2-weighted imaging (TR msec/TE msec = 1,600/120).