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Correspondence

Reply

Department of Cardiothoracic Surgery, Stanford University Medical Center, 300 Pasteur Dr, Falk CVRB CV096, Stanford, CA 94305

(Email: ahmadysheikh{at}yahoo.com).

To the Editor:

We appreciate the comments put forth by Dr Filsoufi and colleagues [1] regarding our article [2] and agree that magnetic resonance imaging is a useful adjunct to help determine the nature of atrial masses preoperatively.

However, in our case, the pre-test probability of a thrombotic mass was relatively low, as the patient had undergone a primary repair of her atrial septal defect as opposed to patch-based repair, which was the case for the patient described by Filsoufi and colleagues [1], as well as others [3]. Given the rarity of thrombus described after primary repair and asymptomatic profile of the patient, our imaging analyses seemingly confirmed our clinical suspicion of myxoma as opposed to thrombus. If a more rigorous approach of magnetic resonance imaging interpretation had been adopted, such as that proposed by Filsoufi and colleagues [1], it is possible that we would have made the diagnosis preoperatively. However, it is important to stress that clinical management would have remained unchanged.

Nonetheless, the case and subsequent discussion highlights the importance of considering rare causes in the face of a seemingly obvious diagnosis, as well as the utility of validated imaging techniques, such as those described by Filsoufi and colleagues' [1] group to help avoid errors in diagnosis.

	References

Top References

 

1. Filsoufi F, Chikwe J, Castillo JG, Sanz J. Multimodal imaging characterization of intracardiac thrombus and myxoma Ann Thorac Surg 2008;85:2162(letter).[Free Full Text]
2. Sheikh AY, Schrepfer S, Stein W, et al. Right atrial mass after primary repair of an atrial septal defect: thrombus masquerading as a myxoma Ann Thorac Surg 2007;84:1742-1744.[Abstract/Free Full Text]
3. Nemirovsky D, Salzberg SP, Einstein AJ, et al. Multimodal characterization of a large right atrial mass after surgical repair of an atrial septal defect Mt Sinai J Med 2006;73:1117-1119.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Marc P. Pelletier Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Sheikh, A. Y. Articles by Pelletier, M. P. Search for Related Content PubMed Articles by Sheikh, A. Y. Articles by Pelletier, M. P. Related Collections Congenital - acyanotic Related Article