Case presentation
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Transcript of Case presentation
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Case presentationWael Tantawy, MD
Cardiologist [email protected] may 2013
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history67 y old saudi female.K/C of HTN, AF on warfarinC/OPresented in her regular F/U with the primary care clinic complaining of SOB & LL edema.
Referred to cardiology clinic & echocardiography was requested.
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Differential DiagnosisLA mass most probably LA myxoma. (abnormal attachment)
LA thrombus. (abnormal place)
Lipoma.Liomyosarcoma.Metastasis from the lung.
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What is the next step?2- Further investigation.1- Course of anticoagulation.
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3- Call the surgeon
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Does the PFO change the decision?
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Continue oral anticoagulation.
F/U echo after 2 weeks.The patient came back after 2 week.She was compliant to her ttt with INR 2.3.TTE was done for F/U
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What are the possibilities ?Liomyosarcoma.
Bleeding inside myxoma.
Metastatics 2ndry to lung Tr
Enlarged thrombus
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What is the next step? 1- Continue anticoagulation.2- Further investigation.
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3-Call the surgeon.
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The increase in mass size despite adequate dose of anticoagulation increase the suspicion of TUMER.
Due to the site of the mass & its encroachment on the Rt upper PV orifices. We elected to do further investigation.
CT Scan chest.
TEE also done for better visualization of the mass attachment
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CT chest
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TEE
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What is the site of attachment of such mass?
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What is the next step?1- Continue anticoagulation.2- Further investigation.3- Call the surgeon.