*Radiology department, Kasr Alainy hospitals, Cairo University, Egypt;
**Fetal medicine unit, Cairo University, Egypt.

Case report

Here we present an illustration of left atrial nodular appearing Coumadin ridge seen at 24 weeks gestation, an anatomical variant not to be mistaken as a left atrial pseudo tumor or left atrial thrombus in otherwise normal heart.

Images 1, 2, 3, 4, 5, 6 videos 1, 2, 3, 4: axial oblique 2D and color Doppler study showing the anatomic relation of left superior pulmonary vein (LSPV) and left atrial appendage (LAA) to the thick nodular appearing Coumadin ridge (being on low velocity with high signal persistence parameters, the Left anterior descending coronary artery (LAD) and its fellow the anterior inter ventricular vein (AIVV) were seen on color Doppler study).

Images 7, 8, 9, 10, 11 videos 5, 6, 7, 8, and 9: Sequential color, glass body, surface and inversion mode rendered volume reformatted images and videos representing the above described 2D findings.