Differential Diagnosis for Echogenic Focus in Left Atrium with Non-visualisation of 3VT Cardiac View

• Single most likely diagnosis:
  • Left atrial thrombus: This is a common cause of an echogenic focus in the left atrium, especially in patients with atrial fibrillation or other conditions that lead to blood stasis.
• Other Likely diagnoses:
  • Myxoma: A benign cardiac tumor that can appear as an echogenic mass in the left atrium, often attached to the interatrial septum.
  • Vegetation: Infective endocarditis can cause vegetations on the mitral valve, which may appear as an echogenic focus in the left atrium.
  • Calcification or fibroelastoma: These are less common but possible causes of an echogenic focus in the left atrium.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Left atrial myxoma with embolic potential: Although myxoma is listed as a likely diagnosis, its potential for embolization makes it critical not to miss, as it can lead to severe consequences if emboli reach the brain or other vital organs.
  • Infective endocarditis with septic emboli: The presence of vegetation due to infective endocarditis can lead to septic emboli, which are life-threatening and require immediate treatment.
• Rare diagnoses:
  • Cardiac metastasis: Metastatic disease to the heart from other cancers can appear as an echogenic focus in the left atrium, though this is less common.
  • Primary cardiac lymphoma: A rare tumor that can involve the heart and appear as an echogenic mass in the left atrium.
  • Papillary fibroelastoma: A rare, benign tumor that can occur on the valves or in other cardiac locations, including the left atrium.