Ann Thorac Surg 2001;72:288
© 2001 The Society of Thoracic Surgeons
Images in cardiothoracic surgery
Multiple ball thrombi in the right atrium: a game of billiards
José M. Bernal, MDa,
J. Aurelio Sarralde, MDa,
José M. Rabasa, MDa,
Fernando Val, MDa,
José M. Revuelta, MDa
a Department of Cardiovascular Surgery, Hospital Universitario Valdecilla, Universidad de Cantabria, Santander, Spain
Address reprint requests to Dr Bernal, Department of Cardiovascular Surgery, Hospital Universitario Valdecilla, Universidad de Cantabria, E-39008 Santander, Spain
e-mail: ccabmj{at}humv.es
A 77-year-old man underwent a Doppler echocardiography because of an embolic episode in the left femoral artery and a cardioembolic stroke. He had a history of atrial fibrillation of 17 year’s duration. A mass in the right atrium compatible with a ball thrombus was seen (Fig 1). At operation, using standard cardiopulmonary bypass and without aortic cross-clamping, three masses floating free in the right atrium were removed (Fig 2). Masses were ovoid in shape (maximal diameters 47, 28, and 19 mm) and showed endothelial peripheral organization with small foci of deep calcification on radiographic examination (Fig 3). Cases of organized thrombi in the right atrium have been reported, but multiple thrombi secondary to long-standing atrial fibrillation is an exceptional finding.
