8) In some cases, atrial thrombi may have stalk and can be diagnosed as myxomas, which can lead to an unnecessary surgical resection.9),10) Rarely, thrombus can be entrapped in patent foramen ovale and it may be confused

with myxoma.11) Potential errors in diagnosis can be made, however, if the characteristics are not well defined, especially if the tumor size is very small or smooth in contour, or attachment site is illdefined.12) Left atrial thrombi are classically found in an atrial Inhibitors,research,lifescience,medical appendage, but can also be found in the body of the left atrium.13) A mass located in the left atrium can be defined as thrombus if it is associated with the presence of atrial fibrillation, enlarged atrial chamber, prosthetic mitral and tricuspid valves, stenotic mitral and tricuspid valves, low cardiac output state, and spontaneous atrial contrast

echoes.12),13) However, in case of left atrial myxoma with mitral stenosis, it Inhibitors,research,lifescience,medical is very difficult to differentiate a thrombus from a myxoma. Left atrial myxomas and thrombi can be differentiated using CT by assessing the distinguishing features of size, origin, shape, mobility, Inhibitors,research,lifescience,medical and prolapse. Myxomas are larger, frequently found in the left atrium and usually originate from fossa ovalis compared to thrombi which most originate from the appendage.14) In this case, three-dimensional TEE could clearly identify the attachment of the left atrial mass to the anteroseptal atrial surface by a narrow stalk. In addition, mobility with cardiac cycle and the absence of any additional masses in the left atrial appendage favor the diagnosis Inhibitors,research,lifescience,medical of cardiac myxoma. But, the presence of stenotic mitral valve together with atrial fibrillation favor the diagnosis of atrial Inhibitors,research,lifescience,medical thrombus. This case suggests that: (1) in a left atrial mass with stalk, differential diagnosis between thrombus and myxoma may be difficult; (2) when the

differential diagnosis is difficult and thrombus is a possibility, a trial of anticoagulation may be advised.
A 72-year-old man was transferred to our emergency department due to the left side weakness. On arrival, he also presented with dyspnea and cough productive of much purulent sputum. Three months prior to the current Olaparib admission, he was hospitalized in a local clinic due to right hemiparesis and was diagnosed with acute left anterior cerebral artery infarction by brain magnetic resonanace imaging (MRI). Chest computed tomography (CT) revealed the mass suspicious of lung cancer in the right lower lobe. The mass was originated from right lower lung field and invaded right pulmonary artery, vein and LA. Biopsy of the lung lesion was recommended for additional diagnostic confirmation but his family rejected the performance of further evaluation. When he visited our hospital, he had a blood pressure of 100/60 mmHg, a pulse rate of 76/min, a temperature of 36.3℃, and a respiratory rate of 25/min.