The left atrial appendage(LAA)is the most common site of left atrial thrombus with more than 90%of thrombi formed within this structure.[1]Transesophageal echocardiography(TEE)is the gold standard imaging technique for identifying LAA thrombus,with sensitivity and specificity both of 95%–100%.[1,2]An imaging modality that is used on most cardiac patients is the transthoracic echocardiogram(TTE).While quick and noninvasive,it is not known for its ability to detect left atrial appendage thrombi.Detecting a thrombus on TTE is a great advantage as it allows for rapid initiation of anticoagulation and avoidance of cardioversion early in atrial fibrillation patients.This case demonstrates the rare occurrence of a patient who was found to be in atrial fibrillation in the setting of thyrotoxicosis who was subsequently discovered to have a left atrial appendage thrombus on TTE.
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