Pulmonary Vein Stump: A Left Atrial Cardioembolic Source.

BACKGROUND

The left atrial appendage (LAA) is the most common nidus for thrombus formation in atrial arrythmias.

CASE SUMMARY: We present a case of acute limb ischemia initially thought to be embolic due to LAA thrombus from atrial flutter. Transesophageal echocardiography before direct current cardioversion demonstrated a LAA without thrombus and favorable filling velocities. However, thrombus was discovered in the postsurgical pulmonary vein stump.

DISCUSSION: Pulmonary vein stumps are becoming recognized as a common source of intracardiac thrombus after lobectomy.

TAKE-HOME MESSAGE: Performing a comprehensive transesophageal echocardiography before direct current cardioversion is paramount to avoid missing thrombi outside the LAA, especially in at-risk populations.