Coumadin Ridge

Coumadin Ridge
Coumadin ridge, also known as a


warfarin ridge or left lateral ridge


“Q-tip sign” on transesophageal echocardiogram


Cotton-Tip Applicator


Coumadin ridge is a band-like structure with a thin proximal part and a bulbous distal part that resembles a cotton-tip applicator. This is known as the “Q-tip sign” on transesophageal echocardiogram.


Coumadin Ridge is a fold of the left atrial wall between the left superior vein and the left atrial appendage.


Visualization of the rounded edge of this ridge on echocardiograms used to result in an erroneous diagnosis of a thrombus, leading to the administration of anticoagulation therapy,


This explains the reason for this finding’s nomenclature as the coumadin ridge.


“Q-tip sign” on transesophageal echocardiogram



Identification of Coumadin Ridge


Unique location of the coumadin ridge between the left superior pulmonary vein and left atrial appendage is an important clue to its identification.

Rounded ridge (arrow) in the LA, between the left atrial appendage (LAA) and the left upper pulmonary vein 


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