Augusta University-Medical College of Georgia, Snellville, GA
Copyright 2016, American College of Chest Physicians. All Rights Reserved.
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
No Product/Research Disclosure Information
Become a CHEST member and receive a FREE subscription as a benefit of membership.
Individuals can purchase this article on ScienceDirect.
Individuals can purchase a subscription to the journal.
Individuals can purchase a subscription to the journal or buy individual articles.
Learn more about membership or Purchase a Full Subscription.
Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited:
Customize your page view by dragging & repositioning the boxes below.
Enter your username and email address. We'll send you a reminder to the email address on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.