Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2021 Dec 20:22:e932582.
doi: 10.12659/AJCR.932582.

Left Atrial Septal Pouch and Acute Thromboembolic Ischemia of the Upper Limb

Esmeralci Ferreira  1 , Dinaldo Cavalcanti de Oliveira  2 , Andressa Braga Barros  1 , Valerio Fuks  3 , Ângelo Antunes Salgado  3 , Márcio José Montenegro da Costa  3 , Sara Cristine Marques Dos Santos  3 , Ivana Aragão  4 , Márcia Bueno Castier  3 , Luiz Kohn  3 , Ricardo Mourilhe-Rocha  3 , Felipe N Albuquerque  3 , Roberto Esporcatte  3 , Denilson Campos de Albuquerque  3
Affiliations
Case Reports

Left Atrial Septal Pouch and Acute Thromboembolic Ischemia of the Upper Limb

Esmeralci Ferreira et al. Am J Case Rep. .

Abstract

BACKGROUND A left atrial septal pouch (LASP) was first described in 2010 as a new anatomical entity with potential for embolic events. The prevalences of left, right, and double septal pouches are 40.8%, 5.1%, and 3.7%, respectively. There is a concern about the risk of embolic events due to formation of thrombi in a LASP (especially stroke). CASE REPORT A 60-year-old man presented with sudden onset of right arm pain associated with sweating and neck pain radiating to his left upper extremity. On physical examination, his right arm was cyanotic and he had pain, paresthesia, and no radial pulse. The patient was diagnosed with acute arterial occlusion of his right upper extremity. An arterial embolectomy was performed with a Fogarty catheter at the level of the brachial artery, which resulted in immediate reperfusion. The patient had an embolic event and after efforts to identify the possible etiology, only an LASP was found. Therefore, we hypothesized that he experienced an embolic event in which a thrombus had formed at the site of the LASP. CONCLUSIONS The present case report is designed to raise awareness of the thrombogenic potential of LASP and the possibility of an embolic event to the upper limb of patients with it. LASP can be the source of a thrombus in a patient with a non-stroke embolic event.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: None declared

Figures

Figure 1.
Figure 1.
The right subclavian artery (RSA) is retroesophageal, but the clinical significance of this finding is unknown.
Figure 2.
Figure 2.
Echocardiographic images. (A–C) Saccular structure in the interatrial septum (left atrial septal pouch [LASP]) that measured 1.1×0.3×0.3 cm. (D) 3-dimensional view of a pouch-shaped structure in the left atrium. RA – right atrium; LA – left atrium.
See this image and copyright information in PMC

References

    1. Krishnan SC, Slazar M. Septal pouch in the left atrium. JACC Cardiovasc Interv. 2010;3:98–104. - PubMed
    1. Mazur M, Jasinska KA, Walocha JA. The morphology, clinical significance and imaging methods of atrial septal pouch: A critical review. Translat Res Anatomy. 2018;13:7–11.
    1. Hołda MK, Krawczyk-Ożóg A, Koziej M, et al. Left-sided atrial septal pouch is a risk factor for cryptogenic stroke. J Am Soc Echocardiogr. 2018;31(7):771–76. - PubMed
    1. Kuwaki H, Takeuchi M, Kaku K, et al. Thrombus attached to the left atrial septal pouch assessed on 3 dimensional transesophageal echocardiography. Circ J. 2011;57(9):2280–81. - PubMed
    1. Hołda MK, Krawczyk-Ożóg A, Koziej M, et al. Cardiac computed tomography compared with two-dimensional transesophageal echocardiography for the detection and assessment of atrial septal pouches. Int J Cardiovasc Imaging. 2018;34(8):1305–13. - PubMed

Publication types