case_images: PMC11788451_01
case_images: Transthoracic echocardiography (TTE) images showing left atrium (LA) thrombi. TTE images showing a hyperechoic region in the LA around the base of the right upper pulmonary vein (RUPV) (arrow).
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case_images: PMC11788451_01_cureus-0017-00000078334-i01.jpg
case_images: FIG1
case_images: Video images from transthoracic echocardiography (TTE). TTE images revealed red flow from the right upper pulmonary vein (RUPV) and a hyperechoic region in the left atrium (LA) around the ostia of the RUPV.. Video images from transesophageal echocardiography (TEE). TEE images revealed several thrombi in the left upper pulmonary vein (LUPV) depicted as small white masses. Some thrombi contain white shadows and move with the heartbeat. Some dark areas can be detected around the white areas. Red indicates blood flow in the LA from the LUPV.. LA: left atrium, LUPV: left upper pulmonary vein. Video images from TEE. Transesophageal echocardiography (TEE) images revealed LA thrombi extending from right lower pulmonary vein (RLPV) thrombi, which appeared as a line-like white mass around the exit of the right middle pulmonary vein (RMPV), and flow from the RMPV could not be detected. The line-like thrombus sometimes contains white shadows and does not move with the heartbeat; however, the thrombus moves with breathing. The white mass is surrounded by dark areas. TEE images revealed another line-like white mass around the exit of the right upper pulmonary vein (RUPV). The right half of the thrombus does not move with the heartbeat; however, the left half of the thrombus moves with the heartbeat. The left ends of the extended LA thrombi are connected to the anterior wall of the LA, and calcified thrombi around the exit of the RUPV have relatively strikingly dark areas. Red indicates blood flow from the RUPV.. Video images from TEE after three months of dabigatran treatment. After three months of dabigatran treatment, TEE revealed several thrombi in the LUPV depicted as small white masses. Some thrombi contain white shadows and move with the heartbeat. Some dark areas in the LUPV decreased, and the red areas in the LUPV area broadened. Red indicates blood flow in the LA from the LUPV area.. Video images from TEE after three months of dabigatran treatment. After three months of dabigatran treatment, TEE images revealed LA thrombi extending from RLPV thrombi, which appeared as a line-like white mass around the exit of the RMPV, and the flow from the RMPV could be detected, indicating resolution of the thrombi located between the line-like white mass and the LA wall. The line-like thrombus sometimes contains white shadows and does not move with the heartbeat; however, the thrombus moves with breathing. TEE images revealed another line-like white mass around the exit of the RUPV, which moves with the heartbeat. The left ends of the extended LA thrombi are connected to the anterior wall of the LA, and calcified thrombi surround the exit of the RUPV. Red indicates blood flow from the RUPV and RMPV.. TEE: transesophageal echocardiography, LA: left atrium, RLPV: right lower pulmonary vein, RMPV: right middle pulmonary vein, RUPV: right upper pulmonary vein
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case_images: PMC11788451_01_.jpg
case_images: VID1
case_images: TEE was performed. TEE revealed several thrombi manifesting as white areas with white shadows in the left upper pulmonary vein (LUPV) (Fig. 2, Video 2) and the right upper pulmonary vein (RUPV) (Fig. 3 and Video 3).
case_images: Transesophageal echocardiography (TEE) images showing thrombi. TEE images showing thrombi in the left upper pulmonary vein (LUPV) (arrows). The thrombi are attached to the wall of the LUPV and present as several hyperechoic regions. The average size of the hyperechoic regions measured approximately 2 mm x 5 mm and were arranged perpendicularly to the direction of the LUPV.. LA: left atrium, LUPV: left upper pulmonary vein
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case_images: FIG2
case_images: In addition, LA thrombi extended from thrombi in the right lower pulmonary vein (RLPV) (Fig. 3, Video 3).
case_images: TEE images showing thrombi. TEE images showing thrombi in the RUPV (white arrows) and the LA (red arrow). The LA thrombi extend from the right lower pulmonary vein (RLPV) thrombi and appear as a white line parallel to the direction of the RLPV. The size of the hyperechoic region is approximately 3 mm x 15 mm. The other several thrombi are attached to the wall of the RUPV and present as hyperechoic regions. These hyperechoic regions measure approximately 3 mm x 7 mm and are perpendicular to the direction of the RUPV. Some parts of the thrombi have white shadows, indicating areas of calcification. Some of the white areas are surrounded by dark areas that connect to other thrombi and are attached to the LA wall.. TEE: transesophageal echocardiography, LA: left atrium, RUPV: right upper pulmonary vein
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case_images: FIG3
case_images: Finally, plain chest computed tomography (CT) revealed calcification around the exit of the RUPV and the right middle pulmonary vein (RMPV) (Fig. 4) and in the LUPV (Fig. 5) as white areas.
case_images: Axial plain computed tomography (CT) images. Axial images depict calcification in the RUPV and right middle pulmopnary vein (RMPV) as white areas (arrows).. LA: left atrium, RMPV: right middle pulmonary vein, RUPV: right upper pulmonary vein
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case_images: FIG4
case_images: Axial plain CT images. Axial images depict calcifications in the LUPV as two white areas (arrows).. AAo: ascending aorta, DAo: descending aorta, LUPV: left upper pulmonary vein
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case_images: FIG5
case_images: However, enhanced CT revealed no thrombi around the exit of the RUPV or RMPV (Fig. 6) or in the LUPV (Fig. 7).
case_images: Axial-enhanced CT images. Axial images depict no thrombi in the LUPV (arrows).. AAo: ascending aorta, LUPV: left upper pulmonary vein
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case_images: PMC11788451_01_cureus-0017-00000078334-i07.jpg
case_images: FIG7
case_images: After three months of dabigatran treatment, these thrombi, including calcifications in the LUPV disappeared (Fig. 8); however, the number of thrombi, including calcifications around the exits of the RUPV and RMPV, decreased (Fig. 9), indicating that these thrombi might be heterogeneous.
case_images: After three months of dabigatran treatment, axial plain CT images. After three months of dabigatran treatment, axial images revealed calcification around the exit of the RUPV and RMPV as white areas (arrows). Compared with Fig. 4, the white areas decreased to some extent, especially around the exit of the RUPV.. LA: left atrium, RMPV: right middle pulmonary vein, RUPV: right upper pulmonary vein
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case_images: FIG9
case_images: TEE images showing thrombi after three months of dabigatran treatment. After three months of dabigatran treatment, TEE images revealed thrombi in the LUPV (arrows). The thrombi are attached to the wall of the LUPV and present as several hyperechoic regions. The average size of the hyperechoic regions measured approximately 2 mm x 4 mm and were arranged perpendicularly to the direction of the LUPV.. LA: left atrium, LUPV: left upper pulmonary vein
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case_images: FIG10