CTICasesExtensive Left Atrial Thrombus Diagnosed with Dual-Energy CT
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Imaging findings
A very large, ugly mass was present in the left atrium, which was also enlarged. The patient had mitral stenosis, a calcified mitral valve, and atrial fibrillation. Dual-energy CT imaging, performed in both arterial and delayed phases, showed no iodine contrast enhancement within the lesion, a stark contrast to the dramatic attenuation changes observed in normal myocardium and blood pool. This was consistent with previous cases that resolved after anticoagulation.
Key takeaways
Dual-energy CT can effectively assess iodine concentration in a lesion, providing valuable tissue characterization. The absence of enhancement was critical in diagnosing this large left atrial mass as extensive layering thrombus, rather than a tumor, particularly in a hypercoagulable patient with a Factor 5 Leiden mutation and a history of strokes. While MRI would have been advantageous for tissue characterization, it was contraindicated due to metal in the patient's eye.
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