CTICasesChronic Left Atrial Thrombus
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Imaging findings
Chest CT shows a massively dilated left atrium with surgical suture lines from a prior cardiac transplant (where native atria were preserved). Inside the left atrium is a large, partially calcified mass. FDG-PET imaging demonstrates that the mass is completely photopenic, with zero metabolic activity. Cardiac MRI confirms that the mass is non-enhancing and behaves as a thrombus, nulling extremely late (inversion times near 600 ms) due to the complete lack of gadolinium uptake, except for a thin line of enhancement at its site of attachment to the atrial wall.
Key takeaways
Chronic left atrial thrombi can become calcified and adhere to the atrial wall over years, mimicking a cardiac tumor such as a myxoma. Cardiac MRI is highly effective in differentiating thrombus from tumor, as chronic thrombi do not enhance internally and have extremely long inversion times, though they may incite peripheral fibrous tissue enhancement where they attach to the chamber wall.
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