CTICasesLeft Atrial Appendage (LAA) Thrombus with Embolic Stroke
Imaging findings
Contrast-enhanced chest CT shows two distinct filling defects in the left atrium: one in the anterior left atrial appendage and another along the posterior wall, consistent with thrombi. A follow-up CT angiogram of the head and neck performed two days later, after the patient developed acute aphasia and hemiparesis, reveals acute occlusion of the internal carotid artery and disappearance of the posterior left atrial thrombus, indicating embolization.
Key takeaways
Atrial fibrillation-induced stasis of blood in the left atrium, particularly within the left atrial appendage, frequently leads to thrombus formation. These thrombi pose a high risk of systemic embolization and ischemic stroke, especially when anticoagulation is contraindicated due to active hemorrhage from coexisting pathology such as colon cancer.
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