Discussion
The incorrect identification of a mass as a LAA thrombus, would cause the initiation of unnecessary anticoagulation therapy or potentially, an evaluation for the excision of the mass if there is a concern about dislodgement. A TEE can reliably distinguish the location of a TS mass, avoiding the initiation of unnecessary investigations or interventions (3). To identify a mass (fat) in the transverse sinus, rotating the transducer will document that it is within the transverse sinus and not the LAA. Transverse sinus fat does not need any intervention for itself, but it is associated with an increased severity of coronary artery disease which necessitates more risk factor control, especially in the context of our patient being a diabetic and dyslipidemic (4). There is similar case of a transverse sinus mass mistaken as a possible aortic abscess (5).
Fig1A. Mass in transverse sinus, thought to be a LAA thrombus
Fig 1b. Mid-esophageal view clarify the mass in transverse sinus
Fig 2A. A focus LAA view showing clean LAA
Fig 2b. Clean LAA
Fig 3. Mass in TS away from PV (pulmonary vein)
Fig 4. A video view by rotating the transducer documented that it is within the transverse sinus and not the LAA