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Case Reports
. 2019 May 21;11(5):e4705.
doi: 10.7759/cureus.4705.

Multimodality Imaging of a Right Atrial Cardiac Mass

Manish Kumar  1 , Supriya Tigadi  2 , Michael A Azrin  2 , Agnes S Kim  2
Affiliations
Case Reports

Multimodality Imaging of a Right Atrial Cardiac Mass

Manish Kumar et al. Cureus. .

Abstract

Work up of a right atrial mass usually requires multimodality imaging and sometimes a biopsy to affirm histological diagnosis. We present a case of a 74-year-old woman with primary cutaneous melanoma (wildtype BRAF) of the right toe who was found to have a large heterogeneous mass in the right atrium on routine surveillance CT scan. She did not have any cardiac symptoms. Vital signs and physical examination were unremarkable. Cardiac magnetic resonance (CMR) imaging demonstrated a bilobed mass with an intramural component and a mobile blood pool component, with interposed thrombus. Three-dimensional transesophageal echocardiogram (3D-TEE) revealed the mass and its site of attachment on the lateral wall of the right atrium. Given the large size of the tumor and its potential for obstruction of tricuspid inflow, the right atrial mass was surgically resected. Pathology confirmed metastatic melanoma. The patient tolerated cardiac surgery well and was discharged shortly thereafter. In the present case, a large cardiac metastasis was discovered in the absence of clinically detectable disease elsewhere. CMR allowed a comprehensive evaluation of the location, extension, and tissue characterization of the cardiac mass. Transthoracic echocardiogram (TTE) and 3D-TEE allowed assessment of the hemodynamic consequences of this mass and aided in operative planning.

Keywords: cardiac mri; echocardiography; melanoma; right atrial mass.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Cardiac MRI imaging of the right atrial mass. Left, SSFP; middle, T1-weighted; right, delayed enhancement images. A bilobed mass (asterisk) was attached to the right atrial wall. The mural component measured 2.3 cm x 4.3 cm x 3.7 cm (TR by AP by cc) and was homogeneously hyperintense to myocardium on T1- and T2-weighted imaging. The mobile, blood pool component of the mass measured 3.1 cm x 4.3 cm x 3.9 cm and was more heterogeneous on T1 than the mural component. The mass demonstrated heterogeneous enhancement on delayed enhancement images. During atrial contraction, the mass appeared to deform the tricuspid valve towards the ventricular cavity.
Figure 2
Figure 2. 3D TEE showing right atrial mass (arrow).
3D TEE, three-dimensional transesophageal echocardiogram.
See this image and copyright information in PMC

References

    1. Malignant tumours of the heart: a review of tumour type, diagnosis and therapy. Neragi-Miandoab S, Kim J, Vlahakes GJ. Clin Oncol (R Coll Radiol) 2007;19:748–756. - PubMed
    1. Metastatic melanoma of the heart. Savoia P, Fierro MT, Zaccagna A, et al. http://10.1002/1096-9098(200011)75:3<203::AID-JSO9>3.0.CO;2-X. J Surg Oncol. 2000;75:203–207. - PubMed
    1. Diagnosis of right atrial mass lesions by transesophageal and transthoracic echocardiography. Obeid AI, Al Mudamgha A, Smulyan H. Chest. 1993;103:1447–1451. - PubMed
    1. Transesophageal echocardiographic evaluation of right atrial mass lesions. Alam M, Irene S, Steven S. J Am Soc Echocardiogr. 1991;4:331–337. - PubMed
    1. Preoperative two and three-dimensional transesophageal echocardiographic assessment of heart tumors. Borges AC, Christian W, Thomas B, et al. Ann Thorac Surg. 1966;61:1163–1167. - PubMed

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