DOI: 10.1111/j.1540-8175.2011.01382.xC© 2011, Wiley Periodicals, Inc.

IMAGE SECTION Section Editor: Ivan D’Cruz, M.D.

Collar Bone Left Atrium

Arunkumar Panneerselvam, M.D., D.M., Rajiv Ananthakrishna, M.D., Prabhavathi Bhat, M.D., D.M., andManjunath C. Nanjappa, M.D., D.M.

Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bangalore, India

(Echocardiography 2011;28:E104-E105)

Key words: thoracic aortic aneurysm, left atrium compression, echocardiography

A 63-year-old man, presented with chestdiscomfort and breathlessness on exertion of6 months duration. On examination his heartrate and blood pressure were normal and theprecordium was unremarkable. His transthoracicechocardiogram revealed a large descending tho-racic aortic aneurysm (8 × 10 cm) compressingthe left atrium (LA) giving it a “collar bone”-like appearance (Fig. 1). This finding of a largeaneurysm was corroborated by an aortogram(Fig. 2). Doppler across the LA showed absence ofleft ventricular inflow obstruction (Figs. 3 and 4).In the apical four-chamber view, the aorta mimicsa cystic tumor-like structure (Fig. 5). There was noevidence of thrombus or aortic dissection.

Conflicts of interest: There is no conflict of interest of authors.No financial grant has been received. There is no relationshipwith industry. Manuscript has been read and approved by allauthors.

Address for correspondence and reprint requests: Dr. Arunk-umar Panneerselvam, M.D., D.M., Sri Jayadeva Institute ofCardiovascular Sciences & Research, Jaya Nagar 9th Block, BGRoad, Bangalore 560069, India. Fax: +918026534477; E-mail:drparun1976@gmail.com

Figure 1. Parasternal long-axis view showing left atrium thatis sandwiched between the thoracic aortic aneurysm and as-cending aorta, giving it a “collar bone”-like appearance. LA =left Atrium; LV = left Ventricle; Ao = aorta.

Figure 2. Aortogram demonstrating aneurysm of descend-ing thoracic aorta.

Echocardiography is the primary imagingmodality to assess LA impressions.1 As patientwas hemodynamically stable inspite of LA com-pression, this constitutes D’Cruz Type II LA

Figure 3. Color Doppler showing laminar flow within the LA.LA = left atrium; LV = left ventricle; Ao = aorta.

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LA Impression by Aorta

Figure 4. Pulse-wave Doppler depicting absence of signifi-cant gradient at the level of mitral valve.

impression.2 Rarely such aneurysms present withsymptoms and signs of heart failure.3 Largeaneurysms compressing LA gives a cystic tumorlike appearance on echocardiogram.4 Hiatus her-nia is an important differential diagnosis that canhave similar echocardiographic appearance. Inthe parasternal long-axis view tracing the peri-cardium on the posterior wall of left ventricleclearly distinguishes the extracardiac nature ofthe structure. Echocardiographic assessment inLA impression by aorta should focus on extentof compression, presence of pulmonary vein ob-struction, left ventricle inflow obstruction, defor-mation of mitral valve anatomy, aortic dissection,

Figure 5. Apical four-chamber view showing the large aorticaneurysm compressing the left atrium. LA = left atrium; LV =left ventricle; RA = right atrium; RV = right ventricle; Ao =aorta.

thrombus formation, and extent of aorticaneurysm.

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3. Celenk MK, Ozeke O, Selcuk MT, Selcuk H, Cagli K. Leftatrial compression by thoracic aneurysm mimicking con-gestive heart failure. Echocardiography 2005;22:677–678.

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