Migrating left atrial appendage thrombus mimicking left atrial tumour embolization
Bibliographic record
Abstract
A 72-year-old woman with known hypertension was urgently referred from a regional hospital for cerebral embolization from a suspected left atrial myxoma. She experienced transient dizziness and vertigo with left arm hypoaesthesia. Imaging revealed multiple supra- and infra-tentorial small cerebral ischaemic strokes. Initial transthoracic echocardiogram (TTE) at the regional hospital described a large mobile left atrial mass protruding through the mitral valve during diastole suggestive of atrial myxoma (white triangles, Panels A and B; Supplementary material online, Movie S1). A transoesophageal echocardiography (TEE) was promptly performed upon admission to our centre to guide possible urgent cardiac surgery but surprisingly revealed no sign of left atrial or appendage mass even after intravenous contrast injection. However, the patient described bilateral quadriceps femoris discomfort without other acute ischaemic signs. A whole-body computed tomography angiography (CTA) demonstrated bilateral deep femoral artery thrombosis (red triangles, Panel C) and splenic infarcts (white arrows, Panel D) without new cerebral strokes. Systemic anticoagulation with unfractionated heparin was started for a suspected left atrial migrating thrombus. Rhythm monitoring during the hospitalization was notable for very frequent short bursts of asymptomatic non-sustained atrial tachycardia without any detected sustained atrial fibrillation or flutter. A large screening for cancer and other thrombophilia was negative. After a comprehensive examination of the initial TTE images (Panel B; Supplementary material online, Movie S2), the diagnosis of migrating left atrial thrombus originating from the left atrial appendage was made. This case highlights the importance of a comprehensive differential diagnosis imaging management. Seven days later, a TEE, CT, and cardiac magnetic resonance were performed and showed complete resolution of the cardiac thrombus and femoral arteries reperfusion. The patient was discharged with lifelong direct oral anticoagulation. Supplementary data are available at European Heart Journal - Cardiovascular Imaging online. Data availability: No new data were generated or analysed in support of this research.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.006 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".