A suspicious left atrial mass in a patient with stroke: Hiatal hernia

A 74-year-old woman was admitted to the neurology department with a history of syncope. Her medical history included diabetes mellitus and hypertension. Electrocardiography showed normal sinus rhythm. Cranial magnetic resonance imaging revealed acute corpus callosum infarction. To identify the potential cardioembolic source, we performed transthoracic echocardiography (TTE), which revealed a large, well-circumscribed, heterogeneous, echodense mass (4.1 cm×3.5 cm) thought to be within the left atrium (LA) (Fig. 1, Video 1). In order to visualize the structure better, we performed transesophageal echocardiography, but no mass was detected in LA (Video 2). Chest computed tomography (CT) revealed an extrinsic, inhomogeneous, large structure located posteriorly to the LA, consistent with a hiatal hernia (HH) (without an intracardiac mass) (Fig. 2). A 24-hour rhythm holter revealed paroxysmal atrial fibrillation. Therefore, anticoagulation was initiated.