Device based closure of the left atrial appendage (LAA) has emerged as a viable approach for stroke prevention in atrial fibrillation (AF) patients with contraindications to chronic oral anticoagulation. One of the most feared complications is device related thrombus formation. We present a 66-year-old male with chronic AF who developed a life-threatening intracranial bleed on oral anti-coagulation. He subsequently underwent LAA closure using an Amplatzer muscular ventricular septal defect closure device for stroke prevention. However, he was found to have a large thrombus attached to the device a year later. We present a review of the various LAA closure devices, importance of periodic surveillance via echocardiography and management options to prevent this complication. Also, the case highlights the importance of contrast-enhance echocardiography in diagnosis of LAA closure device thrombus.
Aged ; Atrial Appendage ; Atrial Fibrillation ; Diagnosis ; Echocardiography ; Heart Septal Defects, Ventricular ; Heart* ; Humans ; Male ; Stroke ; Thrombosis

Objective: To describe a rare case of lipofibromatosis presenting as a head and neck mass in a 6-year-old child. Method: Design: Case Report Setting: Tertiary Public General Hospital Patient: One Result: A six-year-old male child admitted with a large right head and neck region mass underwent complete excision of a possible soft tissue neoplasm following investigations which included Fine Needle Aspiration Cytology, Ultrasonography and Computed Tomography. Histopathological examination yielded lipofibromatosis, a very rare lesion with a distinctive fibrofatty pattern. The patient was well with no recurrence after three months of follow up. Conclusion Although lipofibromatosis is a rare lesion in children and has a predilection for distal extremities, it may also present as a mass in the head and neck area. Complete surgical excision is feasible and is the only treatment option available for this rare lesion