A Case of Embolism due to a Floating Thrombus Migrating from the Left Atrial Appendage to the Ostium of the Celiac Artery

Abstract

The present case was a 70 year-old dialysis patient who had experienced a prior cerebral infarction following atrial fibrillation. Her shunt suddenly occluded during dialysis, and she was transferred to our hospital. Transesophageal echocardiography revealed a floating, ball-like thrombus in the left atrial appendage (LAA). After thrombectomy in the shunt, acute thrombi were extracted. Despite anticoagulant therapy, the ball-like thrombus in the LAA did not dissipate and instead continued to enlarge. We planned surgical intervention involving a left atrial appendectomy without cardiopulmonary bypass through a left thoracotomy. However, her thrombus disappeared out of the LAA when she was intubated in the operating room. Her surgery was, therefore, stopped, and extubation was carried out. A computed tomography (CT) scan showed that the embolism had moved to the ostium of the celiac artery. Incidentally, this celiac artery had already been obstructed, and her inferior mesenteric artery had been the main supply of blood flow to the intestine, explaining why she had not developed intestinal ischemia. We continued anticoagulant therapy with warfarin. Follow-up CT studies were conducted at the outpatient clinic. However, the patient died due to a wide cerebral infarction before the 6-month checkup.