J Korean Soc Radiol.  2019 Nov;80(6):1276-1280. 10.3348/jksr.2019.80.6.1276.

A Case of Coumadin Ridge Confirmed by Surgery: Comparison Between Cardiac Computed Tomographic Images and Operative Findings

• Yeon MR
• Yoo JY
• Kim SJ
• Hong JM

• KMID: 2464927
• DOI: http://doi.org/10.3348/jksr.2019.80.6.1276

Abstract

The coumadin ridge, a ridge of atrial tissue separating the left atrial appendage from the left upper pulmonary vein, is considered to be a normal anatomic variant. A prominent coumadin ridge can be easily mistaken for a tumor or thrombus. In the present case, a left atrial mass was noted on echocardiography and cardiac computed tomography (CT) in a 66-year-old female patient with a history of stroke who experienced chest pain. Therefore, we considered performing a surgery to remove the mass to prevent a recurrence of cerebral infarction, and the mass was confirmed to be a coumadin ridge rather than an actual tumor or thrombus. The findings from the subsequent CT image reconstruction were consistent with the operative findings. We present a surgically confirmed case of coumadin ridge that was consistent with the reconstructed CT image.

MeSH Terms

Aged
Atrial Appendage
Cerebral Infarction
Chest Pain
Echocardiography
Female
Heart
Heart Atria
Humans
Image Processing, Computer-Assisted
Pulmonary Veins
Recurrence
Stroke
Thrombosis
Tomography, X-Ray Computed
Warfarin*
Warfarin

Figure

• 

  Fig. 1 A coumadin ridge mimicking cardiac mass. A–D. Transesophageal echocardiography reveals an echogenic mobile mass at the Q-tip (between the left atrial appendage and left upper pulmonary vein), undulating with cardiac motion (A). A low-attenuation lesion approximately 7 mm in size with a stalk-like structure (white arrows) at the junction of the left atrial appendage orifice (black asterisks) and left upper pulmonary vein (white asterisks) is detected via axial (B), coronal (C), and sagittal cardiac CT (D). The lesion was thought to be a benign tumor such as myxoma or an intracardiac thrombus. E. No abnormal findings were noted other than the left atrial appendage tissue at the preoperatively identified tumor location in the left atrium. There was prominent left atrial appendage tissue (arrow) around the left upper pulmonary vein (asterisk). F. A reconstructed computed tomographic image is consistent with the operative findings. Prominent left atrial appendage tissue was evident (arrow) around the left upper pulmonary vein (asterisk).

Reference

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