2 CASE REPORT
A 63-year-old man with a history of mesh insertion for an abdominal incisional hernia was admitted to the previous physician with the chief complaint of fever. A diagnosis of mesh infection made and long-term antibiotic therapy was initiated. Preoperative echocardiography revealed a 39-mm mass in his left atrium. He was transferred to our hospital for further treatment of mesh infection and LA mass. Echocardiography showed that the LA mass was adherent to the atrial septum (Fig. 1). The ejection fraction was 56%, and no valvular abnormalities were noted. Computed tomography showed a 39-mm partially calcified mass in his left atrium(Fig. 2). Brain magnetic resonance imaging showed very small scattered infarctions; however, he did not have any neurological disorders. Therefore, we suspected LA mass to be an cardiac tumor, especially myxoma, and we scheduled surgery for tumor resection after a 6-week course of antibiotic therapy.
We selected the transseptal approach to reach the left atrium. A smooth-surfaced mass was observed in the left atrium. The mass was severely adherent to the atrial septum and was carefully resected (Fig. 3). The operation time was 4 h and 10 min. Pathophysiology revealed that the excised specimen was a thrombus with Zahn lines composed of fibrin and stratified calcification, indicating the long process of thrombus formation (Fig. 4). There was no tumor component in the specimen. The postoperative course was uneventful, and he was discharged on postoperative day 14, after administering direct oral anticoagulants to prevent thrombus formation. At 6 months after the surgery, follow-up transthoracic echocardiography showed no residual mass in the left atrium, with a preserved ejection fraction of 55%.