A previously fit and well 39-year-old Caucasian female patient was referred from the local district general hospital for further assessment and management of recurrent atrial tachyarrhythmias. A plain chest radiograph exhibited an abnormal left heart border (figure 1A), and initial transthoracic echocardiographic evaluation demonstrated a large intracardiac mass near the left ventricle.
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To further characterise this mass, she then underwent imaging with transoesophageal echocardiography (figure 1B) and magnetic resonance imaging (MRI) of the thorax (figures 1C and 1D). These confirmed a large aneurysm arising from the left atrial appendage. An uncomplicated surgical resection of this aneurysm was performed. Intra-operative findings confirmed both a mass with a cystic structure and the dimensions, established with earlier imaging, of 60 x 50 x 10 mm. Subsequent histological studies confirmed the origin to be of cardiac muscle demonstrating nuclear enlargement consistent with hypertrophy.
At subsequent clinical follow-up the patient remained well with evidence of sinus rhythm on Holter monitoring. A transthoracic echocardiogram performed five months after surgery did not demonstrate any residual aneurysm.
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