IMAGE ARTICLE | VOLUME 2, ISSUE 8 | OPEN ACCESS DOI: 10.23937/2474-3682/1510055

Free Floating Ball Thrombus in the Left Atrium in a Child with Restrictive Cardiomyopathy

Iyad Al-Ammouri

Department of Pediatrics, The University of Jordan, Jordan

*Corresponding author: Iyad AL-Ammouri, MD, Associate professor of pediatric cardiology, Department of Pediatrics, School of Medicine, The University of Jordan, Queen Rania street, Amman 11942, Jordan, Tel: 0096-2653-536-66 ext. 2767, Mobile: 0096-79906-0180, Fax: +96265-300-820, E-mail:

Published: November 15, 2016

Citation: Al-Ammouri I (2016) Free Floating Ball Thrombus in the Left Atrium in a Child with Restrictive Cardiomyopathy. Clin Med Img Lib 2:055.

Copyright: © 2016 Al-Ammouri I. This is an open-access content distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


A large free floating ball thrombus was diagnosed in an 8-year-old girl with severe restrictive cardiomyopathy following transient loss of vision. The thrombus developed despite therapeutic anticoagulation. The child died two days later with a massive embolic stroke.

Idiopathic restrictive cardiomyopathy is a rare disease in children and generally has poor prognosis. The severely dilated atia, along with high incidence of atrial fibrillation results in significant risk of intra-atrial thrombosis [1]. However, free floating ball thrombus remains very rare in children. It is more common in patients with mitral valve stenosis and usually requires urgent surgical treatment [2]. Development of free floating ball thrombus was rarely reported in patients with restrictive cardiomyopathy, even in sinus rhythm [3].

An 8-year-old girl who was diagnosed with idiopathic restrictive cardiomyopathy since the age of 4 years, and has a previous stroke was followed at our institution. She was on anticoagulation with war far in with a stable international normalized ratio of 2-3. She has severe ascites for which she was treated with abdominal paracentesis on a monthly basis. She presented with transient loss of vision. Her echocardiogram showed a large free floating left atrial thrombus (Figure 1). The thrombus was bouncing off the mitral valve with each ventricular systole in supplementary material (online movie). The patient had a fatal major thromboembolic event three days after the diagnosis of the ball thrombus.



Financial Support

This research received no specific grant from any funding agency, commercial, or not-for-profit sectors.

Conflict of Interest



Figure 1: An echocardiographic image in apical view of an eight year old child with severe restrictive cardiomyopathy. There is severe dilatation of both atria, and a large ball thrombus in the left atrium measuring 2.2 cm in diameter.


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  2. Wrisley D, Giambartolomei A, Lee I, Brownlee W (1991) Left atrial ball thrombus: review of clinical and echocardiographic manifestations with suggestions for management. Am Heart J 121: 1784-1790.

  3. Tarhan H, Ocal A, Erbay AR, Yasar AS, Cicekcioglu F, et al. (2005) Free-floating left atrial ball thrombus developed in an 11-year-old child with restrictive cardiomyopathy during sinus rhythm: Manifested as a major thromboembolic event. Int J Cardiol 103: 111-113.