Left Atrial Thrombosis in Achalasia

Abstract

An 81-year-old woman came to the clinic with aphasia and gait disturbance. A transthoracic echocardiogram showed left atrial (LA) thrombus at the posterobasal site, which was compressed by a large mass with high echo intensity. A chest computed tomography scan revealed dilatation of the esophagus, compressing the LA from the posterior side. An endoscopy showed a bolus and much foulness in the distended esophagus, which were imme diately eliminated by an endoscopic procedure. The LA thrombus, as shown by transesophageal echocardiography, spontaneously resolved without any neurologic signs. The authors assumed that the dilatated esophagus compressed the LA, and this may have produced the abnormal flow dynamics in the LA. The injury of endocardial surface produced by the distension or turbulent flow, in addition to dehydration, may have augmented a coagulability in the LA.

Get full access to this article

View all access options for this article.

References

Ali GN , Hunt DR , Jorgensen JO, et al : Esophageal achalasia and coexistent upper esophageal sphincter relaxation disorder presenting with airway obstruction. Gastroenterology 109:1328-1332, 1995 .

Panzini L. , Traube M. : Stridor from tracheal obstruction in a patient with achalasia. Am J Gastroenterol 88:1097-1100, 1993 .

Reisner SA , Brenner B. , Haim N., et al : Echocardiography in nonbacterial thrombotic endocarditis : From autopsy to clinical entity. J Am Soc Echocardiogr 13:876-881, 2000.