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 2016-05-04  Case of the week # 427  © Philippe Jeanty
Answer to the case of the week # 427
August 18, 2016 - September 1, 2016.
Philippe Jeanty1, MD, PhD ; Azer Farajov2, MD; Federico Badano3, MD.

1. Inner Vision Women's Ultrasound, Nashville, Tennessee, USA.
2. German Hospital Fetal Medicine Unit; Lecturer of Radiology unit in Advancing Treining Inistitute of Doctors, Baku, Azerbaijan.
3. FB - Diagnóstico por Imágenes, Gualeguaychú, Entre Ríos, Argentina.


Case report

A 39-year-old woman with unremarkable history was sent to our unit to routine ultrasound. 
Our cardiac examination revealed a round nodular image on the lateral wall of the left atrim.

I (PJ), had no idea what the diagnosis was. I suspected it was a normal variant but could not get further than that. I posted the image on community. Almost immediately Azer provided the answer, rapidly followed by several others. I was humbled that I though I had looked at fetal hearts for so many years and not recognize this before. I was also thankful to all those who immediately found the answer!

The diagnosis was ¨Coumadin ridge¨. This is a prominent, muscular ridge of tissue typically located in the left atrium, between the left superior pulmonary vein and left atrial appendage and is considered a normal anatomy variation.
The differential diagnosis of this normal structure includes: myxoma and thrombus (i
n the past, this structure was often mistaken for thrombus and resulted in patient being prescribed anticoagulation therapy with warfarin (Coumadin) and it is from here that it derives its name).

Image 1, 2 and 3, Video 1: 2D images of the left atrium show a nodular image in the lateral wall typical of Coumadin ridge.


Cardiac drawing shows the usual location an appearance of Coumadin ridge in the left atrium.


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