Organizing Thrombus Mimicking a Cardiac Tumor Located at the Mitral-Aortic Intervalvular Fibrosa

Abstract

Thrombosis at the left ventricular outflow tract occurs without any detectable heart disease or predisposing factors only extremely rarely. A 48-year-old male visited Konkuk University Medical Center with loss of consciousness one month prior to presentation. Before he visited our hospital, he had been diagnosed with a cardiac tumor, which was located between the left atrium and posterior aortic root, and which was adjacent to both the aortic and mitral valves. Cardiac transplantation was recommended at the other hospital because of the high risk of cardiac dysfunction induced by both aortic and mitral valvular dysfunction after surgical resection. Based on preoperative transthoracic echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging, and intra-operative transesophageal echocardiography, we considered it to be a benign tumor. Complete resection was achieved and the pathology confirmed organizing thrombus. We report a case of organizing thrombus mimicking a cardiac tumor, which was located at the mitral-aortic intervalvular fibrosa of the left ventricular outflow tract without any heart disease.

Keywords: False aneurysm; Left ventricular outflow tract; Mitral-aortic intervalvualr fibrosa; Thrombosis.

Fig. 1

Preoperative cardiac computed tomography with enhancement show a mass partially filled with contrast material from LV during systole. Asterisk (*) indicates a pseudoaneurysm. LA, left atrium. LV, left ventricle. M, organized thrombus.

Fig. 2

Schematic diagram of intraoperative findings. LA, left atrium. LVOT, left ventricular outflow tract. NCS, non-coronary sinus of Valsava sinus. Ps, pseudoaneurysm. RCS, right coronary sinus of Valsava sinus. S, interventricular septum. T, organized thrombus. Asterisk (*) indicates mobile portion of pseudoaneurysm.

Fig. 3

A specimen. Two lumps of round and soft masses, measuring 3.5×4.2×2.2 cm.