Archived case 174 · January 23-January 30, 2015
Left juxtaposition of the atrial appendage
40 year old patient with supraventricular tachyarrhythmia.
The question posed to readers
What is the relevant finding?
Images
Imaging findings
This is an anatomic defect usually associated with congenital heart disease. Historically it has been diagnosed at surgery or autopsy. More recently, however, diagnosis has been made with echocardiography and catheter angiography, though it can still be difficult to detect. Cardiac MR is a very sensitive exam for detection of this finding. Left juxtaposition of the atrial appendage in itself is not especially clinically relevant, as it does not represent a shunt or other circulatory malfunction. It is usually associated with congenital heart disease, however, and it may affect the surgical or catheter approach because of the atypical anatomy. Answer Diagnosis: Left juxtaposition of the atrial appendage
Diagnosis
Left juxtaposition of the atrial appendage
Congenital heart defect associations:
-Transposition of the great arteries (in more than 90%)
-ASD (78%)
-VSD (65%)
-hypoplastic right heart with outflow obstruction (50%) or inflow
obstruction (41%)
Clinical importance:
-May affect surgical or catheter approach approach because of atypical anatomy.
-Does not represent a shunt or other circulatory malfunction.
References:
Charuzi Y, Spanos PK, Amplatz K, Edwards JE. Juxtaposition of the
atrial appendages. Circulation. 1973 Mar;47(3):620-7. PubMed PMID:
4692216.
Frescura C1, Thiene G. Juxtaposition of the atrial appendages.
Cardiovasc Pathol. 2012 May-Jun;21(3):169-79.
Rice MJ, Seward JB, Hagler DJ, Edwards WD, Julsrud PR, Tajik AJ. Left
juxtaposed atrial appendages: diagnostic two-dimensional
echocardiographic features. J Am Coll Cardiol. 1983 May;1(5):1330-6.
PubMed PMID: 6833673.Original case written by its authors at Virginia Commonwealth University and published at this address as part of a weekly teaching collection. Reproduced here as an archive.