Cardiology

72-year-old woman after a left atrial appendage occluder

Clinical introduction

A 72-year-old woman presented for routine echocardiography 6 months following percutaneous insertion of a left atrial appendage occluder (LAAO) due to atrial fibrillation with contraindications to anticoagulation. The procedure was uncomplicated, and she was clinically well. On echocardiography an abnormality was seen in the posterior pericardial space (Figure 1, arrows).

Figure 1

Transthoracic Echocardiogram: left, parasternal long axis. right, parasternal short axis view.

Question

This finding represents:

  • Tumour.

  • Haematoma post-LAAO.

  • Pericardial effusion.

  • Epicardial fat.

  • Answer D

    D. This is epicardial fat, between the visceral and parietal layers of the heart. Often mistermed ‘pericardial fat’, the layer of brown epicardial fat is highly variable in distribution1. This appearance was present on review of preprocedural echocardiograms and confirmed on gated Cardiac CT which had been performed prior to LAAO insertion; the Hounsfield units…

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