The Diagnosis of Intra-Auricular Thrombosis in the Living

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Abstract
Soft mural thrombi, as well as those which have calcified, can under certain conditions be recognized in standard roentgenograms of the heart. In a series of 771 necropsied patients with all types of heart disease, the incidence of intra-auricular thrombosis was 34.4%. Few have been recognized clinically and still fewer roent-genographically when it is of sufficient size or when it is impregnated with Ca. The non-calcified soft mural thrombi are more difficult to diagnose. The roentgen finding of a prominent 3d left arc along the left lateral cardiac contour immediately above the upper demarcation point of the left ventricle, as seen in the postero-anterior projection, is strongly suggestive of thrombus in the left auricle. The bulge usually represents the left auricular appendage; when this is prominent, auricular thrombi are frequently present. It is suggested that the evidence contributed by kymography and angiocardiography demonstrates that the left auricular appendage forms a substantial part of this curve. Right heart enlargement with subsequent counter-clockwise rotation of the heart may displace the left auricular appendage backward; the conus segment then appears on the left contour of the heart.

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