Catheter-related giant right atrial thrombosis mimicking a myxoma: A case report

Abstract

Despite the development of imagistic methods, the differential diagnosis of a right atrial mass may be difficult to be established, the most common pathologies which should be taken in consideration being represented by thrombus, tumors, prominent crista terminalis, or vegetation of infectious endocarditis. In this study, we present the case of a 63-year-old man with chronic kidney disease, in hemodialysis (HD) with a silicone central venous catheter (CVC) with the incidental transthoracic echocardiography (transthoracic echocardiogram, TTE) finding of a tumoral mass of 35x26 mm in the right atrium (RA), not related with the catheter, which was diagnosed as right atrial myxoma and underwent surgical excision. After reviewing the histopathology probe, the diagnosis of right atrial thrombus was confirmed. In conclusion, differentiating intracardiac right atrial masses (RAMs) could may prove challenging. In our patient, clinical presentation and the preoperative investigations could not differentiate the right atrial thrombus from a myxoma, and only the postoperative histopathology diagnosis was able to guide correct diagnosis.

Keywords: hemodialysis; myxoma; right atrial mass; right atriotomy; thrombus.

Figure 1

TTE examination revealed a right atrial echogenic mass of 17/18 mm, independent of the catheter tip. TTE, transthoracic echocardiogram.

Figure 2

Intraoperator view-right atriotomy approach revealed atrial mass located lateral to the coronary sinus venosus orifice with no related with catheter tip.

Figure 3

On gross pathological specimen, the right atrial mass was an ovoid, firm, smooth red-tan to dark red-tan surface (2.5x1.5 cm).

Figure 4

Microscopic views showed focal accumulation of hemosiderin-containing histiocytes, significant deposit of fibrin, and proliferation of the blood vessels and fibroblasts (HE, x40).