Image in Cardiology
An asymptomatic case of a giant left atrium
Um caso assintomático de uma aurícula esquerda gigante
Filipa Valente
, David Durão, José Loureiro, Isabel Monteiro
Corresponding author
Hospital de Santarém, Santarém, Portugal
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class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "David" "apellidos" => "Durão" ] 2 => array:2 [ "nombre" => "José" "apellidos" => "Loureiro" ] 3 => array:2 [ "nombre" => "Isabel" "apellidos" => "Monteiro" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Hospital de Santarém, Santarém, Portugal" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Um caso assintomático de uma aurícula esquerda gigante" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1622 "Ancho" => 1583 "Tamanyo" => 148040 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Chest X-ray, posteroanterior view, showing marked cardiomegaly (cardiothoracic ratio 0.92) and splaying of the carina (arrows).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 59-year-old woman, an agricultural worker, came to the emergency department (ED) due to fever and odynophagia. She had an irregular pulse, a predominantly apical systolic-diastolic murmur on cardiac auscultation, reduced bilateral breath sounds on pulmonary auscultation, dullness on dorsal percussion of the thorax and mild peripheral edema. The ECG revealed atrial fibrillation at 93 bpm.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The chest X-ray showed marked cardiomegaly (cardiothoracic ratio 0.92) and splaying of the carina and of the main bronchi (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Echocardiography revealed a giant left atrium (GLA), with an anteroposterior diameter of 10.5 cm and a volume indexed to body surface area of 1054 ml/m<span class="elsevierStyleSup">2</span> (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a> and Video 1); dome-shaped mitral valve, suggesting a rheumatic etiology (Video 2), with severe regurgitation and stenosis; and severe tricuspid regurgitation, with pulmonary artery systolic pressure of 74 mmHg.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The patient refused further intervention and follow-up. A year later, after coming to the ED for a hand injury, she returned to work and continued to refuse treatment.</p><p id="par0025" class="elsevierStylePara elsevierViewall">GLA is defined as a left atrium with an anteroposterior diameter of ≥8 cm on echocardiography or reaching the right lateral side of the chest wall on X-ray. It is associated with rheumatic mitral valve disease, in particular with severe mitral regurgitation, and it thus rarely asymptomatic. Symptoms occur due to the underlying valve disease, but can also result from compression of the esophagus or airways or from thromboembolic events. Its appearance on X-ray may be confused with pleural or pericardial effusion or with a tumor, and cases have been reported of “thoracocentesis” and “biopsy” in patients with GLA. Correct diagnosis is thus essential to avoid iatrogenic complications.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Right to privacy and informed consent" ] ] ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-10-09" "fechaAceptado" => "2013-11-06" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Valente F, Durão D, Loureiro J, et al. Um caso assintomático de uma aurícula esquerda gigante. Rev Port Cardiol. 2014;33:315–316.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0055" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="upi0010"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0035" ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1622 "Ancho" => 1583 "Tamanyo" => 148040 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Chest X-ray, posteroanterior view, showing marked cardiomegaly (cardiothoracic ratio 0.92) and splaying of the carina (arrows).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1457 "Ancho" => 1583 "Tamanyo" => 103356 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Transthoracic echocardiogram, apical 4-chamber view, showing giant left atrium distorting the geometry of the other chambers. AD: right atrium; AEG: giant left atrium; VD: right ventricle; VE: left ventricle.</p>" ] ] 2 => array:7 [ "identificador" => "upi0005" "etiqueta" => "Movie 1" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 319139 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:2 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Transthoracic echocardiography, apical 4-chamber view, clearly showing a giant left atrium compressing and distorting the geometry of the other chambers.</p>" ] ] 3 => array:7 [ "identificador" => "upi0010" "etiqueta" => "Movie 2" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc2.mp4" "ficheroTamanyo" => 292394 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc2.flv" "poster" => "mmc2.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:2 [ "fichero" => "mmc2.m4v" "poster" => "mmc2.jpg" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Transthoracic echocardiography, parasternal long-axis view, showing the mitral valve with thickened leaflets and reduced dome-shaped opening in diastole, suggestive of rheumatic valve disease.</p>" ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003300000005/v1_201407070904/S2174204914001214/v1_201407070904/en/main.assets" "Apartado" => array:4 [ "identificador" => "9915" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in cardiology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003300000005/v1_201407070904/S2174204914001214/v1_201407070904/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204914001214?idApp=UINPBA00004E" ]
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| 2018 October | 111 | 18 | 129 |
| 2018 September | 39 | 14 | 53 |
| 2018 August | 37 | 6 | 43 |
| 2018 July | 32 | 3 | 35 |
| 2018 June | 38 | 5 | 43 |
| 2018 May | 68 | 9 | 77 |
| 2018 April | 74 | 5 | 79 |
| 2018 March | 81 | 10 | 91 |
| 2018 February | 62 | 5 | 67 |
| 2018 January | 48 | 13 | 61 |
| 2017 December | 84 | 5 | 89 |
| 2017 November | 33 | 13 | 46 |
| 2017 October | 33 | 12 | 45 |
| 2017 September | 47 | 6 | 53 |
| 2017 August | 38 | 14 | 52 |
| 2017 July | 45 | 12 | 57 |
| 2017 June | 43 | 9 | 52 |
| 2017 May | 41 | 15 | 56 |
| 2017 April | 36 | 10 | 46 |
| 2017 March | 54 | 7 | 61 |
| 2017 February | 55 | 3 | 58 |
| 2017 January | 43 | 5 | 48 |
| 2016 December | 36 | 9 | 45 |
| 2016 November | 47 | 10 | 57 |
| 2016 October | 66 | 2 | 68 |
| 2016 September | 100 | 8 | 108 |
| 2016 August | 39 | 4 | 43 |
| 2016 July | 24 | 5 | 29 |
| 2016 June | 23 | 2 | 25 |
| 2016 May | 23 | 5 | 28 |
| 2016 April | 39 | 1 | 40 |
| 2016 March | 55 | 11 | 66 |
| 2016 February | 63 | 28 | 91 |
| 2016 January | 42 | 13 | 55 |
| 2015 December | 42 | 5 | 47 |
| 2015 November | 48 | 8 | 56 |
| 2015 October | 53 | 9 | 62 |
| 2015 September | 61 | 11 | 72 |
| 2015 August | 45 | 12 | 57 |
| 2015 July | 67 | 7 | 74 |
| 2015 June | 20 | 3 | 23 |
| 2015 May | 30 | 6 | 36 |
| 2015 April | 39 | 9 | 48 |
| 2015 March | 26 | 2 | 28 |
| 2015 February | 35 | 7 | 42 |
| 2015 January | 58 | 9 | 67 |
| 2014 December | 48 | 26 | 74 |
| 2014 November | 38 | 15 | 53 |
| 2014 October | 41 | 11 | 52 |
| 2014 September | 60 | 13 | 73 |
| 2014 August | 51 | 15 | 66 |
| 2014 July | 83 | 25 | 108 |
Show all
