This document summarizes a case study of a rare congenital left atrial appendage aneurysm in a 20-year-old female patient presenting with fever, breathlessness, and chest pain. Imaging including radiography, ultrasound, cardiac CT, and MRI revealed a partially thrombosed bilobed peripherally calcified aneurysm arising from the left atrium. A diagnosis of a congenital left atrial appendage aneurysm was made based on the multimodality imaging findings. Differential diagnoses included sinus of Valsalva aneurysm. The condition was discussed as a rarely reported entity that can pose diagnostic challenges but be definitively diagnosed using cardiac imaging modalities.

1. Rare case of Congenital Left Atrial Appendage
Aneurysm- Its Multimodality Imaging
Presented by:- Sahil Garg (PG Resident)
Co Authors- Abhijit Patil, Ashish Ashtekar,
V.M Kulkarni
Department of Radiodiagnosis
Dr DY Patil Medical College , Pimpri,Pune

2. Clinical Profile
 A 20 year old female from Pune, Maharashtra, presented in medicine OPD with
fever and breathlessness on and off with chest pain since 5 years.
 Associated history of headache and weakness with pain in the lower limbs since
5 years
 Patient did not delineate any past history of surgery or any hospital admission.
 There was no history of joint pain or any chronic illnesses like TB, HTN, DM
and Seizures.
 Patient was seronegative for HIV.
 Systemic examination revealed split S2 with end systolic murmur at pulmonary
area and systolic murmur at mitral area.

3. Radiograph – AP and Lateral view
PA ViewPA View Left Lateral ViewLeft Lateral View
RadiographRadiograph of chest PA and left lateral revealed convex opacity between inferior border of theof chest PA and left lateral revealed convex opacity between inferior border of the
aortic knob upto upper half of left cardiac border with peripheral curvilinear calcification. Theaortic knob upto upper half of left cardiac border with peripheral curvilinear calcification. The
lateral projection revealed the hilar location of the lesion below the left main stem bronchus.lateral projection revealed the hilar location of the lesion below the left main stem bronchus.

4. USG Findings
AA BB
USGUSG revealed partially thrombosed vascular structure communicatingrevealed partially thrombosed vascular structure communicating
with the left side of the heart. The residual lumen showed pulsatile flow.with the left side of the heart. The residual lumen showed pulsatile flow.

5. Cardiac CT
Cardiac CT revealed a partially thrombosed bilobed peripherally calcified aneurysm with its
communication to left atrial appendage.

6. Cardiac MRI
Non thrombosedNon thrombosed
aneurysm arisinganeurysm arising
from the leftfrom the left
atriumatrium
Thrombosed part ofThrombosed part of
aneurysmaneurysm
LALA
LVLV
RARA
RVRV
Cardiac MRICardiac MRI revealed a partially thrombosed bilobedrevealed a partially thrombosed bilobed
aneurysm of the left atrial appendage.aneurysm of the left atrial appendage.
LALA
RARA
LVLV
ANEUANEU

7. Diagnosis- Bilobed peripherally calcified Left atrial
appendage aneurysm
Differential diagnosis –Sinus of valsalva aneurysm.

8. Discussion
 Left Atrial aneurysms are usually secondary to mitral valve
disease.
 Congenital Left Atrial Appendage aneurysm is a rare anomaly
described by Semans and Taussig in 1938.
 These aneurysms mimic mediastinal or cardiac tumours on
routine radiography.

9. Discussion (Contd.)
 Sinus of Valsalva aneurysm is a differential diagnosis for left
atrial appendage aneurysm
 Cardiac and coronary CT / MR provide a conclusive diagnosis
and helps in differentiating it from sinus of valsalva aneurysm.
 The syndrome, if not diagnosed and treated early may lead to
complications like systemic emboli, arrhythmias and eventually
death

10. Conclusion
 Congenital left atrial appendage aneurysm is very rarely
reported entity.
 Such cases with unusual clinical presentation may pose a
diagnostic challenge.
 USG provides an easily accessible modality for confirming the
location and communication with the mediastinal vascular
structures.
 Cardiac and coronary CT / MRI are the gold standard for the
diagnosis

11. References
 Parakh N, Yadav N, Chaturvedi V, GeelaniM:Giant left atrial
appendage: Postgrad Med J 2011;87:436-437.
 Gościniak E, Larysz B,Jurczyk K,Kasprzak J:Five-chambered
heart: Eur Heart J (2009).
 Victor S and Nayak V: Aneurysm of the Left Atrial Appendage:
Tex Heart Inst J.2001:28(2):111-118.
 Hassan M, Said K, Hamamsy I, Abdelsalam S Et al: Giant
Congenital Left Atrial Appendage Aneurysm: J Am Coll
Cardiol. 2013;61(4):478-478.

12. Thank You