The Utility of Cardiac Computed Tomography in Distinguishing a Coumadin Ridge

A 60-year-old woman was admitted to our hospital with acute myeloid leukemia. Routine transthoracic echocardiography (TTE) was performed to evaluate her cardiac function before bone marrow transplantation. TTE revealed a moving structure with a rounded edge in the left atrium, suspected to be a myxoma (Fig. 1 A-B and Supplementary Video 1). Cardiac computed tomography (CT) showed no cardiac masses in the left atrium, but multiplanar reconstruction images revealed that the mass from the TTE image matched a ‘coumadin ridge’ (Fig. 1C and D), which is not an anomaly but a normal or variant anatomy. We also performed cine CT images through the cardiac cycle, which demonstrated that the coumadin ridge apparently had mobility, as was observed on TTE (Supplementary Video 2). Thus, cardiac CT was effective for the correct diagnosis of the structure that was identified on TTE— a coumadin ridge. She received the bone marrow transplantation as scheduled.