Imaging: Student/Resident Case Report Poster - Imaging |

Left Juxtaposition of the Right Atrial Appendage FREE TO VIEW

Naomi Gunadeva, BS; Ruchit Shah, MD; Jayanth Keshavamurthy, MD; Gyanendra Sharma, MD
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Augusta University-Medical College of Georgia, Snellville, GA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):672A. doi:10.1016/j.chest.2016.08.766
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SESSION TITLE: Student/Resident Case Report Poster - Imaging

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Left juxtaposition of the right atrial appendage (RAA) is a rare condition that is commonly associated with cyanotic congenital cardiac defects, and it can lead to difficulties in interpreting images and in procedural settings.

CASE PRESENTATION: A 27 year-old female presents with chest pain and has a double-outlet right ventricle (SDL type) and ventricular septal defect that was repaired as an infant. She had a previous implantable cardioverter defibrillator (ICD) that was removed with the epicardial leads abandoned. Subsequently, she had a left-sided permanent, trans-venous dual chamber ICD placed. On a lateral chest x-ray obtained on presentation, the right atrial (RA) lead was noted to be posteriorly directed (Fig A - red arrow).

DISCUSSION: A cardiac computed tomography (CT) was obtained for better visualization of the RA lead. Axial and coronal maximal intensity projection (MIP) CT imaging revealed that the RA lead was placed in the RAA. The RAA and left atrial appendage (LAA) can be identified by the ridges of the pectinate muscles (yellow/purple arrow) in Fig B, as can the delineation between the right and left atrial appendages (green arrow). The RAA is typically anterior to the aorta and the RA. The location of the RAA in our patient is next to the LAA, combined with the above findings on cardiac CT, suggested a diagnosis of left juxtaposition of the RAA.

CONCLUSIONS: Although the orientation of the RA lead was posterior, it was deemed to be appropriately placed by cardiac CT.

Reference #1: Rice MJ, Seward JB, Hagler DJ, Edwards DW, Julsrud PR, Tajik AJ. Left juxtaposed atrial appendages: diagnostic two-dimensional echocardiographic features. J. Am. Coll. Cardiol. 1983;1 (5): 1330-6.

DISCLOSURE: The following authors have nothing to disclose: Naomi Gunadeva, Ruchit Shah, Jayanth Keshavamurthy, Gyanendra Sharma

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