CTICasesMalpositioned Watchman Device with LAA Thrombus
Imaging findings
CT chest shows a Watchman left atrial appendage (LAA) closure device improperly seated with its disk tilted, allowing persistent flow into the appendage (leakage). A large thrombus is visualized on the device surface and extending into the LAA lumen, along with a separate thrombus on an adjacent pacemaker lead.
Key takeaways
Proper seating and sizing of LAA exclusion devices (like the Watchman) are critical. Incomplete closure or leakage allows persistent flow into the appendage, generating stagnation and high risk of thrombus formation on the device or within the LAA, necessitating systemic anticoagulation.
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