It is important to discern the nature of any mass that may appear on the left atrial (LA) ridge, or “coumadin ridge,” which is situated between the LA appendage and the left superior pulmonary vein prior to any procedures involving the left atrium. Despite the rarity of the appearance of LA ridge mass, the shape and location are important in distinguishing a cardiac tumor or thrombus.1 In this case report, a mass on the LA ridge was discovered during an intracardiac echocardiogram prior to transseptal puncture for ablation of atrial fibrillation, posing a diagnostic dilemma and leading to a cascade of imaging studies.
