Left Atrial Appendage

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The left atrial appendage can be seen on some transthoracic adult studies.

The left upper pulmonary vein is adjacent to the left atrial appendage. They are separated by a fold of tissue which can be quite visible on both transthoracic and transesophageal echocardiography. A persistent left superior vena cava occupies this space when it is present.

The tissue fold may resemble a mass on some transthoracic images as shown above, and indeed, quite often does so on transesophageal images, as shown below.

Ligament of Marshall

This vestigial fold of the pericardium contains fibrous bands, small blood vessels and nervous filaments surrounded by fat.
It courses obliquely above the left atrial appendage and lateral to the left superior pulmonary vein.
It contains the oblique vein of Marshall that drains into the coronary sinus.

Original description by John Marshall: On the development of the great anterior veins in man and mammalia: including an account of certain remnants of foetal structure found in the adult, a comparative view of these great veins in the different mammalia, and an analysis of their occasional peculiarities in the human subject.
Phil Trans R Soc Lond 1850;140:133-69

Unusually serpiginous left atrial appendage.

Normal Doppler flow pattern in the left atrial appendage. There is appendage emptying following the P wave and appendage filling following the QRS.

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The contents and links on this page were last verified on November 18, 2012

by Dr. Olga Shindler