Patients with Atrial fibrillation (AF) are quite prone to develop atrial clots due to stasis from impaired atrial contractile function. While left atrial (LA) and left atrial appendage (LAA) thrombi are quite common, right atrial (RA) and right atrial appendage (RAA) clots are uncommonly seen. Structural and functional differences between RAA and LAA have been implicated in lower prevalence of RAA clots in AF patients. We report here simultaneous LAA and RAA clots in a patient with Rheumatic heart disease, mitral stenosis and Atrial fibrillation. Though current guidelines do not make a specific mention of RAA assessment, we highlight the fact that a comprehensive echocardiographic evaluation of both atrial appendages is of paramount importance in atrial fibrillation patients especially those who are planned to undergo balloon mitral valvotomy or cardio version.
Key words: Right atrial appendage, Left atrial appendage, atrial fibrillation, Mitral stenosis, clot.