Al-Ammouri. Clin Med Img Lib 2016, 2:055 Clinical Medical Image Library ClinMed International Library Volume 2 | Issue 8 ISSN: 2474-3682 Free Floating Ball Thrombus in the Left Atrium in a Child with Restrictive Cardiomyopathy Image 2:055 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. Information Iyad Al-Ammouri* *Correspondence: 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: Iyad72@hotmail.com Department of Pediatrics, The University of Jordan, Jordan Abstract A large free foating 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. 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. Idiopathic restrictive cardiomyopathy is a rare disease in children and generally has poor prognosis. Te severely dilated atia, along with high incidence of atrial fbrillation results in signifcant risk of intra-atrial thrombosis [1]. However, free foating 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 foating 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 foating lef atrial thrombus (Figure 1). Te thrombus was bouncing of the mitral valve with each ventricular systole in supplementary material (online movie). Te patient had a fatal major thromboembolic event three days afer the diagnosis of the ball thrombus.