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Stroke is an important clinical problem and some strokes are caused by a cardiac thrombus. Although large thrombus in the left atrium (LA) is known, small-sized LA thrombus is rare. LA thrombus or a left atrial appendage (LAA) thrombus is well known to cause ischaemic stroke in patients with atrial fibrillation (AF). For patients with AF, anticoagulants are recommended to prevent stroke. 64-slice multidetector CT (64-MDCT) can estimate not only the coronary artery stenosis, but LAA thrombus and small pulmonary vein thrombus (PVT). This study demonstrated the thrombi in the left lower pulmonary vein to LA in a 70-year-old man without AF by 64-MDCT. The LA thrombi were identified by transthoracic echocardiography, the size of which was 30.2 mm×8.1 mm. PVT and the small LA thrombus seem to have been significantly underestimated. 64-MDCT is a useful tool to estimate PVT and LA thrombi promptly.

64-MDCT can depict the thrombi expanded from the left lower pulmonary vein to the left atrium in the patient with angina pectoris