Giant Left Atrium
http://www.100md.com
《新英格兰医药杂志》
A 59-year-old woman with a history of rheumatic heart disease presented with an eight-month history of increasing ascites. Her condition was complicated by mitral stenosis, which had required a Bjork–Shiley mitral-valve replacement 20 years earlier. Chest radiography showed massive cardiomegaly (Panels A and B). A computed tomographic scan of the chest (Panel C) revealed severe enlargement of the left atrium (LA), which measured 15.0 by 15.8 cm and filled the entire lower right hemithorax; the scan also revealed anterior displacement of the Bjork–Shiley valve (arrow) and compression of the left ventricle (LV), right ventricle (RV), and right atrium (RA) against the anterior chest wall. Echocardiography showed abrupt cessation of diastolic expansion of the interventricular septum, with a rapid Y descent on hemodynamic tracings — findings consistent with a constrictive physiological process. The patient was treated with serial large-volume paracentesis, and an aggressive diuretic regimen was started. However, she died shortly after admission as a result of newly diagnosed acute myelogenous leukemia. A giant left atrium has been described almost exclusively in rheumatic heart disease due to pancarditis with eccentric dilatation.
Roderick Tung, M.D.
Roman DeSanctis, M.D.
Massachusetts General Hospital
Boston, MA 02114
Roderick Tung, M.D.
Roman DeSanctis, M.D.
Massachusetts General Hospital
Boston, MA 02114