Multimodality imaging for the differential diagnosis of a cardiac pseudotumor: the mazy case of Coumadin Ridge
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Author(s)
Abstract
The Coumadin/Warfarin ridge (CWR), also known as “Q-tip” sign in cardiac magnetic resonance (CMR) imaging, consists in a prominent muscle ridge lying in the left atrium, in-between the left atrial appendage and the insertion of left upper pulmonary vein; due to its shape and position it is often misdiagnosed as a left atrial myxoma or a thrombus, without regression despite anticoagulation therapy with warfarin (Coumadin). We present here, a particularly rare condition in which an extraordinary prominent ridge was firstly misdiagnosed as a cardiac mass and secondly as a Cor Triatriatum Sinister. Awareness of CWR location, and both echocardiographic and CMR features, can help avoiding misdiagnosis and overtreatments, even if particularly prominent as in our case.
Keywords
Cardiac masses; Pseudotumors; Cor triatriatum; Coumadin ridge; Multimodality imaging.
Cite this paper
MD, FACC, FESC, Valentina Bucciarelli, Piergiusto Vitulli, Sabina Gallina,
Multimodality imaging for the differential diagnosis of a cardiac pseudotumor: the mazy case of Coumadin Ridge
, SCIREA Journal of Clinical Medicine.
Volume 4, Issue 2, April 2019 | PP. 31-38.
References
[ 1 ] | Paraskevaidis IA, Michalakeas CA, Papadopoulos CH, Anastasiou-Nana M. Cardiac tumors. ISRN Oncol 2011;2011:208929. |
[ 2 ] | Hoey ET, Shahid M, Ganeshan A, Baijal S, Simpson H, Watkin RW. MRI assessment of cardiac tumours: part 1, multiparametric imaging protocols and spectrum of appearances of histologically benign lesions. Quant Imaging Med Surg 2014;4 (6 ):478-88 |
[ 3 ] | Nassar PN, Hamdan RH. Cor Triatriatum Sinistrum: Classification and Imaging Modalities. Eur J Cardiovasc Med 2011;1(3):84-87. |
[ 4 ] | Bianco F, Bucciarelli V, Todiere G, Barison A, Festa P, Ait-Ali L, Gallina S, De Caterina R, Aquaro GD. [Cardiac tumors: role of magnetic resonance imaging]. G Ital Cardiol (Rome) 2017;18(4):286-294. |
[ 5 ] | Lodhi AM, Nguyen T, Bianco C, Movahed A. Coumadin ridge: An incidental finding of a left atrial pseudotumor on transthoracic echocardiography. World J Clin Cases 2015;3(9):831-4. |