Volume 4, Number 2 (2019)
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Home > Journals > SCIREA Journal of Clinical Medicine > Archive > Paper Information

Multimodality imaging for the differential diagnosis of a cardiac pseudotumor: the mazy case of Coumadin Ridge

Volume 4, Issue 2, April 2019    |    PP. 31-38    |PDF (342 K)|    Pub. Date: April 7, 2019
73 Downloads     558 Views  

Author(s)
MD, FACC, FESC, Institute of Cardiology, “G.d’Annunzio” University, Chieti, Italy
Valentina Bucciarelli, Institute of Cardiology, “G.d’Annunzio” University, Chieti, Italy
Piergiusto Vitulli, Institute of Cardiology, “G.d’Annunzio” University, Chieti, Italy
Sabina Gallina, Institute of Cardiology, “G.d’Annunzio” University, Chieti, Italy

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. Vol. 4 , No. 2 , 2019 , pp. 31 - 38 .

References

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[ 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.

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