A Giant Free-Floating Left Atrial Thrombus With a Flipper Effect.

Authors

Lorenzo Niro, Gianluca Sclafani, Teresa Cammelli, Anna Maria Traini, Riccardo Codecasa, Pierluigi Stefano, Anna Toso

Published in

JACC. Case reports. Pages 109788. Aug 12, 2026. Epub Aug 12, 2026.

Abstract

Left atrial (LA) masses may be diagnostically challenging in patients with atrial fibrillation, previous mitral valve surgery, and severe LA remodeling.
A 77-year-old woman with permanent atrial fibrillation and a bileaflet mechanical mitral prosthesis underwent pacemaker implantation. Predischarge transthoracic echocardiography revealed a large LA mass. Transesophageal echocardiography showed a heterogeneous mobile mass, raising the differential diagnosis of thrombus vs myxoma. After intravenous unfractionated heparin, repeat transesophageal echocardiography demonstrated a giant free-floating mass intermittently impinging on the prosthetic discs without increased transprosthetic gradients. Contrast-enhanced computed tomography showed no postcontrast enhancement. Urgent surgery removed the mass, which was macroscopically consistent with thrombus.
Serial transesophageal echocardiography, particularly with 3-dimensional imaging, can identify dynamic changes in mass mobility and guide prompt management before embolic or prosthetic obstructive complications occur.
A free-floating LA thrombus near a mechanical mitral prosthesis may require urgent surgery despite normal gradient.

PMID:
42593380
Bibliographic data and abstract were imported from PubMed on 13 Aug 2026.

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