Figure 8 shadow, what is your diagnosis?

Hassan H Allam; Abdulhalim Jamal Kinsara; Tareq Tuiama; Shadwan E Alfakih

doi:10.4103/jcecho.jcecho_90_20

CASE REPORT

Year : 2020 | Volume : 30 | Issue : 3 | Page : 177-178

Figure 8 shadow, what is your diagnosis?

Hassan H Allam¹, Abdulhalim Jamal Kinsara², Tareq Tuiama¹, Shadwan E Alfakih¹
¹ Department of Cardiology, King Abdullah Medical Complex, Ministry of Health, Jeddah, Saudi Arabia
² Department of Cardiology, Ministry of National GuardHealth Affairs, King Saud Bin Abdulaziz University for Health Sciences, COMWR, King Abdullah International Medical Research Center, Jeddah, Saudi Arabia

Date of Submission	01-Aug-2020
Date of Decision	03-Sep-2020
Date of Acceptance	07-Sep-2020
Date of Web Publication	05-Nov-2020

Correspondence Address:
Abdulhalim Jamal Kinsara
Department of Cardiology, Ministry of National Guard.Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, COM-WR, King Abdullah International Medical Research Center, Jeddah
Saudi Arabia

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jcecho.jcecho_90_20

Abstract

We report this case, which described the echocardiographic and chest X-ray appearance of the amplatzer device. The echo images raised suspicion of a mass in the left atrium, but a simple X-ray showed that the mass is an amplatzer device for left atrial appendage closure.

Keywords: Amplatzer, atrial fibrillation, left atrial appendage closure

How to cite this article:
Allam HH, Kinsara AJ, Tuiama T, Alfakih SE. Figure 8 shadow, what is your diagnosis?. J Cardiovasc Echography 2020;30:177-8

How to cite this URL:
Allam HH, Kinsara AJ, Tuiama T, Alfakih SE. Figure 8 shadow, what is your diagnosis?. J Cardiovasc Echography [serial online] 2020 [cited 2023 Jan 31];30:177-8. Available from: https://www.jcecho.org/text.asp?2020/30/3/177/300093

On presentation, a 65-year-old woman complained of dyspnea on exertion. Her son reported a history of hypertension and that a pacemaker was inserted. She developed an irregular pulse, and a direct oral anticoagulant was prescribed, however, she developed alveolar hemorrhage after the treatment. The decision was made to perform a second percutaneous cardiac intervention. Her transthoracic echocardiography showed an abnormal shadow [[Figure 1]-arrow]. The same shadow was noted in other standard echo views: apical 2 and 3.

Figure 1: The Amplatzer Cardiac Plug device is an alternative non-surgical method to occlude the left atrial appendage, in certain cases of atrial fibrillation. During the echocardiogram examination, it may be visible as an abnormal shadow in the form of a number eight

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Question

What is the abnormal finding and what is the diagnosis?
Which simple test revealed the diagnosis?

Answer

The amplatzer cardiac plug (ACP) device is an alternative nonsurgical method to occlude the left atrial appendage (LAA) in certain cases of atrial fibrillation (AF). During the echocardiogram examination, it may be visible as an abnormal shadow in the form of a number 8
Chest X-ray disclosed the diagnosis and showed the ACP geometry [Figure 2].

Figure 2: (a) Chest X-ray disclosed the diagnosis and showed the Amplatzer Cardiac Plug geometry. (b) Chest X-ray - A focused view on Amplatzer Cardiac Plug

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Discussion

The left atrium is a frequent source of embolic stroke, particularly in patients with AF.^[1] The majority of AF-induced thrombi are formed in the LAA. In patients with AF, with a contraindication to use anticoagulation to prevent stroke, an alternative has been a goal for years. The introduction of the LAA percutaneous closure is a relatively safe and promising technique for the prevention of stroke.^[2]

The shadow of an ACP is recognized and in the form of a number 8 on the transthoracic echocardiogram. The epitrochoid geometry of the ACP, which is the result of the interaction between the mesh and ultrasound waves, is seen as a number 8. Recognizing this artifact's shadow as normal will also serve as a method to assess the position of the device.^[3]

Consent for publication

Written informed consent was obtained from the patient (s) for their anonymized information to be published in this article.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that their name and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Beinart R, Heist EK, Newell JB, Holmvang G, Ruskin JN, Mansour M. Left atrial appendage dimensions predict the risk of stroke/TIA in patients with atrial fibrillation. J Cardiovasc Electrophysiol 2011;22:10-5.
2.	Park JW, Bethencourt A, Sievert H, Santoro G, Meier B, Walsh K, et al. Left atrial appendage closure with Amplatzer cardiac plug in atrial fibrillation: initial European experience. Catheter Cardiovasc Interv 2011;77:700-6.
3.	Bertrand PB, Grieten L, De Meester P, Verbrugge FH, Mullens W, Verhaert D, et al. Etiology and relevance of the figure-of-eight artifact on echocardiography after percutaneous left atrial appendage closure with the Amplatzer Cardiac Plug. J Am Soc Echocardiogr 2014;27:323-80.