Large left atrial thrombus resection in a patient in sinus rhythm without mitral valve disease: A case report

INTRODUCTION: Left atrial (LA) ball thrombi are often associated with atrial fibrillation (AF) and mitral valve disease (MVD). Differentiating between thrombi and LA tumors can be challenging. PRESENTATION OF A CASE: A 63-year-old man with a prior mesh insertion for abdominal incisional hernia was admitted with fever. He was diagnosed with an abdominal mesh-related infection requiring surgical debridement. Preoperative transthoracic echocardiography revealed a 39-mm smooth mass in the LA adherent to the atrial septum. The mass was suspected to be a cardiac tumor based on the morphology. The patient underwent mass resection. Pathophysiology revealed that the mass was a thrombus, necessitating anticoagulation therapy. No recurrence of thrombus formation was reported. DISCUSSION: In this case, a plausible factor causing the thrombus formation is the chronic mesh. Since LA thrombi can become free-floating or grow rapidly, early surgical intervention is essential to prevent thrombotic events or sudden death. CONCLUSION: An LA thrombus should be included in the differential diagnosis when an LA mass is detected. Prompt surgical resection prevents thrombotic events and improves patient outcomes.